Healing heart disease, strokes, cholesterol and high blood pressure
Do you have heart disease in your family and want to lower your risk? Or have you had issues with blood pressure, heart attacks, blocked arteries or struggled with high cholesterol? Or are you confused about what to eat? Read on to learn how these diseases develop and what can be done about them. We use all the standard tests plus the latest Functional Medicine tests, and then use a nutrition first, drugs last approach to reverse and prevent disease.
***Always discuss with your doctor before making any changes to your medication, supplements, exercise routine or diet***
Modern food is addictive and bad for our health
The latest Australian research shows that people with obesity don’t get the same brain signals that would normally make them feel satisfied after a meal, so they keep eating. Research has now discovered that gut hormones enter the brain, and some are in fact produced in the brain itself, and these influence cognitive (mental) ability.[1] In addition, well-established regulators of synaptic plasticity, such as brain-derived neurotrophic factor, can function as metabolic modulators, responding to peripheral signals such as food intake. In other words, our mind and body are one.
Our modern world has food that is often very high in both fat and carbohydrate, something rarely found in nature. This combination is highly addictive. It causes short term bursts of high blood sugar, then crashes. This is addictive but also terrible for our health as it creates Advanced End Glycation Products. These are toxic sticky substances that damage the blood vessel wall. They are a bio-marker implicated in aging and the development, or worsening, of many degenerative diseases, such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer's disease. [2]
The picture below is an electron microscope view of the inside of a blood vessel. The thin threads are the Gylcocalyx layer, which normally protects the artery from damage. The little hairs induce Nitric Oxide to be released which opens up blood vessels and provides a bumper so the red blood cells, cholesterol and other things in your blood don’t damage the fragile wall of your arteries. Nitric oxide is given as a medication to patients in heart failure, as the heart and brain need oxygen and the tiny blood vessels have lost the ability to open up normally.
Maintaining a healthy glycocalyx may be the most important way of preventing strokes and heart disease!
After a single high carbohydrate meal the blood vessels in your body get damaged.
When the Gylcocalyx is damaged, LDL cholesterol is more able to damage the blood vessel wall and turns into an atheroma[3]. See the electron microscopic picture to the right - carbohydrate meals destroy this protective Gylcocalyx barrier, like felling trees in a forest. Then the artery is vulnerable to damage, which causes atherosclerosis that can lead to heart disease and strokes. It takes 8 hours for the body to heal the Gylcocalyx, but most people are then having another unhealthy meal, so the arteries can never recover.
Toxins and inflammatory chemicals such as TNF-α promote early atherosclerosis by increasing transcytosis of LDL across the deeper cells (endothelial)[4].
Thus inflammation can turn a potentially harmless level of LDL cholesterol in the blood into a dangerous atheroma in the wall of the blood vessel, that could lead to strokes and heart attacks.
Eating too much added sugar increases the risk of dying from heart disease even if your not overweight. In this 15-year study on participants who ate 25% or more of their daily calories as sugar were more than twice as likely to die from heart disease!
Sugar has been shown to have a key role in causing atherosclerosis, high blood pressure (hypertension), fatty liver and damages mitochondria which then leads to numerous other diseases.
Modern fruit is full of sugar and damages the health of animals
The Age reported in 2018 that selective breeding has made the fruit we eat so full of sugar, that Melbourne Zoo has had to wean its animals off it. "The issue is the cultivated fruits have been genetically modified to be much higher in sugar content than their natural, ancestral fruits,” says Dr Michael Lynch, the zoo’s head vet. "It's interesting. After doing a lot with nutrition here, I tend to eat less fruit." “Pretty much all cultivated varieties at present are sweeter than their wild counterparts,” says Dr Senaka Ranadheera, a food scientist at the University of Melbourne. "For example, wild apples are smaller and more bitter than modern cultivated varieties." Dr Ranadheera said there were reports of some fruits, such as plums, almost doubling in soluble sugar content in the past 20 years” (due to farmers breeding higher yielding, sweeter varieties). [5]
Newsweek also reported that the Zoo had found the fruit made the animals fat and rotted their teeth.[6]
Refined starches are also bad for your health
Recent research done by the University of Auckland and Starship Children's Hospital using data from the country's largest longitudinal study of child development, Growing Up in New Zealand, found that refined starches - such as white bread, rice, noodles and breakfast cereals, cause tooth decay in children.
We now know that healthy bacteria in the mouth = healthy teeth. In fact there are more than 800 species of bacteria that colonize the oral mucous, 1,300 species found in the gingival crevice and 1,000 different species that comprise dental plaque. "Hunter-gatherers had really good teeth," says Alan Cooper, director of the Australian Centre for Ancient DNA. "But as soon as you get to farming populations, you see this massive change. Huge amounts of gum disease. And cavities start cropping up." And thousands of years later, we're still waging, and often losing, our war against oral disease. Trying to kill all the bacteria in our mouth, good and bad, isn't working. In a study published in the latest Nature Genetics, Cooper and his research team looked at calcified plaque on ancient teeth from prehistoric human skeletons. What they found was that as our diets changed over time — shifting from meat, vegetables and nuts to carbohydrates and sugar — so too did the composition of bacteria in our mouths, which then led to tooth decay.
Obesity and metabolic syndrome are strongly associated with cancer, and these disorders may share a common mechanism. Recent experimental evidence showed that fructose (fruit) intake was associated with cancer growth and exhibits distinct effects as compared to glucose (sugar), including production of uric acid (associated with gout) and lactate as major byproducts. Fructose transporters are upregulated in various malignant tumors. It promotes the "Warburg effect" to preferentially downregulate mitochondrial respiration and increases aerobic glycolysis that aids cancer spreading (metastases).
Why is there so much confusion around what works for weight loss, and what is healthy?
An interesting article in the Journal of Insulin Resistance said "The sugar industry has a long history of co-opting scientists. A team at the University of California, San Francisco, have discovered the paper trail of influence by the Sugar Research Foundation to exonerate sugar and divert attention to saturated fat as a cause of cardiovascular disease (CVD) in 1967, and to divert attention away from sugar as a cause of dental caries in 1971. Since then, those in the sugar, high-fructose corn syrup, beverage and processed food industries have paid for scientists’ complicity in marketing sugar as healthy. More recently, an analysis of Web of Science citations from 2008 to 2016, which searched for Coca-Cola conflicts of interest regarding funding, identified 779 articles.”[7] Many people in the media have likened industry’s resistance to the implementation of a sugar tax to the behaviour of the tobacco industry in the past when they tried to delay health warnings about smoking.Furthermore, it’s very hard to perform studies because people tend to under report the bad food they eat and over report the good food. Frequently studies also use different definitions of low carbohydrate” or “good fat” or even the definition of “red meat”! Large differences in environmental exposures and lifestyle also confound studies. The greatest challenge though is that most research is done by large corporations with a vested interest in the outcome.
Slowly but surely, independent studies are being done now and they are proving again and again that the low fat approach is flawed. Eating less calories and exercising more won’t work in the long term for weight loss. You know first hand that’s true.
Unfortunately artificial sweeteners are not the answer. Research has shown they change the microbiome in an unhealthy way, so then our gut bacteria promotes obesity and diabetes. There is also evidence that the body gets confused with the sweet input without calories, which leads to increased weight and feeling hungry all the time.
Eating Saturated Fat doesn’t cause you to become fat
The world is increasingly waking up to the fact that eating fat can actually make you thin. Fat though high in calories is processed differently by the body than other fuel sources and tends to make you feel full. It also burns slower so you have more consistent energy throughout the day. Many ultra-endurance athletes now use fat as their fuel rather than carbohydrate gels and snacks. Even peak sports teams are now embracing this new paradigm as their performance is increased by it.
We are witnessing an epidemic of obesity and diabetes because people are eating food that they are not genetically designed to eat. Your ancestors never ate most of what we consider “food” in our modern age. Importantly, neither did people living in your country in the 1950s. It’s only really since the 1960s that our diet has dramatically changed, and that has paralleled the increases in cancer, diabetes and obesity. At the same time we’ve been exposed to thousands of toxins and chemicals that are now being shown to build up in our bodies over decades and cause all sorts of problems.
More and more studies are showing that to lose weight, eating fat can actually help. However, it needs to be in conjunction with eating the right amounts of proteins and carbohydrates. Fat alone won’t make you thin, but the entire approach will.
The good news is it means our weight loss approach includes plenty of tasty food including cream, butter, eggs, nuts and meat. (If you are vegan you can still use this approach, it’s simply modified to be plant based).
When the food guidelines were introduced they encouraged people to eat a low fat diet, this meant they had to increase their carbohydrate intake as a proportion of their calories. This has had disastrous consequences to our health and clearly those guidelines do the opposite of what they were intended to achieve. Food consumption patterns changed, and so did the rates of obesity. A decade or so later diabetes started going up as well.
The Early Childhood Longitudinal Study, (Birth Cohort), was a representative sample of US children that found low fat intake leads to obesity. 10,700 children were examined at age 2 and 4. Across racial/ethnic and socio-economic status subgroups, 1% (skim milk) drinkers had higher BMI scores than 2% (whole fat milk) drinkers. “Increasing fat content in the type of milk consumed was inversely associated with BMI score (p<0.0001)… children drinking 1% skim milk at both 2 and 4 years were MORE LIKELY to become overweight/obese between these time points."[8]
What about eggs? In 3 large international prospective studies including 177,000 individuals, 12,701 deaths, and 13,658 cardiovascular events from 50 countries in 6 continents, researchers did not find significant associations between egg intake and blood lipids, mortality, or major cardiovascular events!!
Fat tissue is not just spare padding – it’s a source of hormones!
Adipose tissue (fat) is no longer considered to be an inert tissue that just stores fat in the body. It is now known to be an endocrine organ. Adipose tissue is responsible for the synthesis and secretion of several hormones that control nutritional intake (leptin, angiotensin), control sensitivity to insulin and inflammatory process mediators (tumour necrosis factor α (TNF-α), interleukin-6 (IL-6), resistin, visfatin, adiponectin, among others) and pathways (plasminogen activator inhibitor 1 (PAI-1) and acylation stimulating protein (ASP) for example).[9] This is a big part of why being overweight increases the risk of thrombotic disorders contributing to endothelial dysfunction and, subsequently, to accelerated atherosclerosis (heart attacks and strokes) .[10]
Within fat tissue, enzymes such as aromatase and aldo-keto reductase 1C are responsible for metabolizing testosterone into estrogen and 5-dihydrotestosterone into inactive metabolites. Adipose tissue can also affect the secretion of gonadotropin, which influences the formation of androgen in the testes. This is why many overweight men develop “man boobs”, may lose hair and feel less confident in themselves. Their testosterone is being converted to estrogen because of the fat! This then feeds back and higher estrogen causes more fat to be deposited. Furthermore, androgens regulate the activity of lipoprotein lipase, a key enzyme involved in intracellular esterification of adipose tissue. When this mechanism is interfered with adipose tissue becomes dysfunctional.
Eating Saturated Fat doesn’t cause coronary heart disease or strokes
National dietary guidelines were introduced in 1977 and 1983, by the United States and United Kingdom governments, with the ambition of reducing deaths from Cardiovascular disease by reducing or modifying fat intake. Australia soon adopted similar approaches and so began the war on fat.
At the time of researcher Zoë Harcombe’s PhD thesis, no analysis of the evidence base for these recommendations had been undertaken. Her PhD examined the epidemiological and Random Control Trial (RCT) evidence available to the US and UK regulatory committees at their respective points of implementation. The thesis also examined the epidemiological and RCT evidence available currently, to assess if the guidelines are supported at the present day. Dr Harcombe conducted four systematic reviews and meta-analyses of the RCTs and epidemiological evidence available, firstly, at the time of introducing the guidelines, and secondly, now, examining the relationships between dietary total and saturated fat, serum cholesterol and all-cause or CHD mortality.
Her results indicate that 6 RCTs (including only 2,467 males – most of whom had already had a heart attack) published prior to 1983 were available to the dietary guideline committees: 5 secondary prevention studies and 1 including healthy subjects.
There were no differences in all-cause mortality and non-significant differences in Coronary Heart Disease mortality, resulting from the dietary interventions. In other words there was no evidence that a low fat diet would reduce heart attacks or all-cause mortality.[11]
None of the studies themselves recommended a low fat diet based on their results. In fact 3 of them concluded NOT to use a low fat diet to avoid heart attacks!
Similarly, 6 epidemiological studies available to the committee at the time of the dietary guidelines did not find any relationship between all-cause and coronary heart disease mortality and dietary saturated fat.
Dr.Zoe Harcombe described the famous 7 Countries study as “the lowest possible form of evidence”, and a review of the original data found a much stronger correlation between latitude and heart disease than cholesterol levels, possibly pointing to vitamin D deficiency being the real cause of those heart attacks.
Very Low Carb Ketogenic Diet (VLCKD) vs Low Fat Diet (LFD)
Including more recent RCTs and epidemiological studies (including the Women’s Health Initiative study) in the analysis did not change the findings of No Effect. Even if an effect had been evident, most studies included only males, who had pre-existing heart disease, making results difficult to generalise to the greater, healthy population.
Dr Harcombe concludes that government dietary fat recommendations were untested in any trial prior to being introduced and current evidence does NOT support the current low fat dietary guideline. The modern dietary guidelines have been a mass experiment with the populations’ health and the result has been disastrous. Health authorities don’t understand the problem is the very core hypothesis the original recommendations were based on were flawed, so it’s no wonder that people are getting fatter and sicker following them. It’s time to re-evaluate the evidence and adopt a new approach.
A recent study found that lowering cholesterol with plant sterols can be harmful to your health![12] Modern studies are pointing to things like smoking, trans-fat, high blood pressure, and diabetes as the cause of heart disease, not saturated fat.
Dietary cholesterol does NOT increase blood cholesterol in most people.[13] Dietary fat may increase blood cholesterol in some people (while decreasing triglycerides), but this increase does not relate to increased Cardiovascular risk or mortality risk possibly due to reduced atherogenic cholesterol particles, and increased antiatherogenic particles.[14]
For decades the standard for assessing arterial disease and heart attack risk has relied predominantly on monitoring blood risk factors, with low density lipoprotein (LDL) levels considered the ultimate marker of risk. However, the coronary artery calcification (CAC) score is a more direct measure and far superior as an indicator of atherosclerosis and cardiac event risk. In comparison to the CAC score, the LDL level appears to be a very poor indicator of heart attack risk and potentially even misleading[15]. Studies have found that despite increasing CAC scores (patients who are at high risk of having a heart attack), they can have similar LDL levels to people who are low risk.
A study of 58,000 Japanese people over 14 years showed higher saturated fat intake actually resulted in LOWER risk of strokes and heart disease.
https://www.acpjournals.org/doi/10.7326/M13-1788?articleid=1846638&atab=7&
Modern vegetable oils can be toxic and are now suspected as being the cause of Alzheimer’s and other “modern” lifestyle diseases
Red meat is OK in moderation
Guidelines published in the Annals of Internal Medicine in 2019 say there’s no need to reduce red meat consumption for good health. Based on five systematic reviews of the relationship between meat consumption and health, a panel of researchers from Dalhousie and McMaster universities in Canada, with the Iberoamerican and Polish Cochrane centers, says that most people can continue to consume red meat and processed meat at their average consumption levels. Analyzing the data from five studies that encompassed 54,000 people, the researchers did not find a significant association between meat consumption and the risk of heart disease, diabetes or cancer. They also found a vegetarian diet provided few, if any, health benefits. That is not to say you shouldn’t eat vegetables, but rather you should focus on whole food, and part of that can be red meat. A serving size of steak is approximately the size of the palm of your hand.
A plant based (vegan) diet can be fine, if it is constructed properly. Many people on a vegan diet are low in choline, taurine, creatine, B12, iron and vitamin A. For optimal health all nutrients need to be accounted for.
At Evergreen Doctors for most of our patients we use the IFM CardioMetabolic food plan that is a very well constructed modernised Mediterranean style diet. It is anti inflammatory, full of nutrition and tasty.
Some patients have issues like diabetes that needs to be reversed, you can read about how we do that without medication here.
Or you might want to lose weight and so we use a variety of approaches such as a ketogenic diet, intermittent fasting, the Prolon Fasting Mimicking Diet, or others, each customised to your unique health situation and personal preferences.
Toxins can cause high blood pressure, heart disease and strokes
https://www.abc.net.au/news/rural/2020-03-19/international-glyphosate-roundup-hotspot-map/12063156
Food allergies can cause obesity and atherosclerosis
The gut plays a major role in health and in disease. Read more about the Microbiome here and how we help patients heal their gut.
All aspects of health need to be factored in and addressed. For example sleep problems or high stress both play key roles in many diseases.
Read more about sleep here
New tests can reveal if your cholesterol is actually high risk or not and new natural treatments can be life changing
For example lipid particle testing shows if your LDL is the big fluffy safe kind, or the oxidised small toxic kind that causes heart disease. Simply counting all LDL as “bad” and all HDL as “good” is very out of date. Some HDL types are protective, others are not. You can have a “high” LDL and be healthy, and have a “low” LDL and be unhealthy. Measuring the subset with a lipid particle test reveals the truth.
Blood pressure should be measured using a 24 hour ambulatory device to see what your blood pressure does overnight when you sleep, rather than just a one off reading, or even an average. If your blood pressure doesn’t drop overnight that is a bad sign, and is called being a “non dipper”.
CT Coronary Artery Calcium Scoring is another new tool that enables far more precise risk stratification to occur than a basic cholesterol blood test done by a GP.
Many other advanced tests are now available such looking at your apolipoproteins. These molecules carry cholesterol in your blood as tiny particles called lipoproteins. Apo A is an apolipoprotein that is part of the high-density lipoprotein (HDL) particle.
At Evergreen Doctors we offer you all the latest testing and then provide a personalised holistic plan to optimise your health, reverse disease and prevent disease. We use a nutrition first, drugs last approach.
Our goal is not to treat a number on a blood test, or just treat a symptom, but to optimise all areas of your health including sleep, gut, mood, hormones, immune function, cognition and so on.
We use the standard AND the latest Functional Medicine tests like checking your omega 3 ratio. Getting your omega 6 to 3 ratio down to 4 or lower will reduce your risk of heart disease mortality by 70%!!
We also use the latest proven neutraceuticals that can have a profound impact. You can read a thorough review of many of these in this Journal Article from Clinical Lipidology here.
For example a new patented form of vitamin E after just 4 weeks reduced total cholesterol 15%, LDL cholesterol 18% and triglycerides by 14%! C-reactive protein (CRP), an inflammation marker decreased 40%, cytokines associated with cardiovascular disease such as TNF-alpha, IL2, IL4, IL6, IL8 were also reduced between 39% and 64%. No medication can do that!
Not all supplements are created equal!
For example many brands of fish oil were found to have gone off (oxidised) so they weren’t helpful.
Discuss with your doctor before using a sauna, and be sure to have adequate water and electrolytes.
Discuss with your doctor before starting any neutraceutical as they can interact with medication
Always discuss with your doctor before starting an exercise program
Always discuss with your doctor before starting any exercise program
In this double-blind randomised controlled trial conducted over six months, researchers found sustained improvements in vascular function, cholesterol and underlying nitric oxide bioactivity after consuming one cup of blueberries per day for six months. The study highlights the power of the right nutrient, in the right dose for the right indication. “In the longest-duration blueberry randomised controlled trial to date, conducted in 115 adults with metabolic syndrome, we report evidence for the following:
•1 cup (150 g) blueberries/d for 6 months resulted in sustained and clinically relevant improvements in endothelial function, systemic arterial stiffness, and HDL cholesterol concentrations (especially in statin non-users)
•Increased cGMP levels, HDL cholesterol particle density, and apoA-I levels are likely to be underlying improvements in vascular and lipid status”
According to the researchers, anthocyanins undergo extensive metabolism in the lower intestines when ingested with these metabolites serving as growth substrates for the gut microbiome and therefore likely to play a key beneficial metabolic role.
“With effect sizes predictive of 12-15% reductions in cardiovascular disease risk, blueberries should be included in dietary strategies to reduce individual and population cardiovascular disease risk” the authors concluded.
Curr Opin Lipidol. 2016 Aug; 27(4): 408–413.
Discuss with your doctor before starting any neutraceutical as they can interact with medications
Discuss with your doctor before starting any neutraceutical as they can interact with medication, do not stop any medication without discussing it with your doctor
Discuss with your doctor before starting any neutraceutical as they can interact with medications
Monkey on right looks younger and had the health benefits listed, from eating twice a day rather than 3 times a day
Imagine how different the health system would be if all doctors embraced the nutrient first, drugs last approach that we at Evergreen Doctors are so passionate about! Targeted nutrients can be powerful when used the right way!
https://www.sciencedaily.com/releases/2020/08/200825110754.htm
Do genetics matter?
Not as much as we are led to believe. Our “family medical history” is often related more to diet, lifestyle and toxin exposures than genetics. You are born with genes, how those genes are actually expressed is based largely on your environment (“epigenetics”). Our genes have not changed much for a very long time yet in the last few decades many “modern” diseases have become major problems. Many forms of cancer are increasing (not just better diagnosis), diabetes, obesity, heart disease, high blood pressure and many auto immune diseases and allergies are now more common than ever before.
A recent study found daily blueberry consumption lead to differential expression (>1.2-fold) of 608 genes and 3 microRNAs, with Mir-181c undergoing a 13-fold increase in peripheral blood mononuclear cells. This means certain nutrients directly influence our immune system and genetic expression! Patterns of 13 blueberry metabolites were independent predictors of gene expression changes and significantly modulated biological processes involved in cell adhesion, migration, immune response, and cell differentiation.[16] Impressively, micronutrient therapy has even found to be effective in the reduction of aggressive and violent behaviours in male children and adolescents in a 16 week trial.[17].
Our genetics can have a role in how we process cholesterol, and medications. The most well studied genetic variant in terms of heart health (and dementia) is ApoE. If all the other lifestyle, diet, nutraceutical approaches are not working then being aware of your ApoE status may help.
A magical drug is not the answer
Medications though sometimes useful, can have unwanted side effects, and recent research has reevaluated whether they are as effective as once thought.
**You should not stop your medication until you have improved all your cardiovascular risk factors, and discussed it with your doctor first**
You can use this Mayo Clinic risk/benefit calculator with your doctor to discuss statin use.
You can also look at the Number Needed to Treat to understand the benefit or risk of taking statins in different groups of patients.
The good news is there are many natural ways using diet, lifestyle and key neutraceuticals that have been shown in studies to have a profound effect on your cholesterol, inflammation, weight, blood sugar and blood pressure.
Book an appointment with Evergreen Doctors today and start your journey to optimal health.
References
[1] Mittal, R., Debs, L.H., Patel, A.P., Nguyen, D., Patel, K., O’Connor, G., Grati, M., Mittal, J., Yan, D., Eshraghi, A.A., Deo, S.K., Daunert, S., Liu, X.Z. (2017, September). Neurotransmitters: The critical modulators regulating gut-brain axis. Journal of Cellular Physiology, 232 (9): 2359-2372. Doi: 10.1002/jcp.25518.
[2] Vistoli, G; De Maddis, D; Cipak, A; Zarkovic, N; Carini, M; Aldini, G (Aug 2013). "Advanced glycoxidation and lipoxidation end products (AGEs and ALEs): an overview of their mechanisms of formation" (PDF). Free Radic Res. 47: Suppl 1:3–27. doi:10.3109/10715762.2013.815348. PMID 23767955.
[3] "Arterial glycocalyx dysfunction is the first step in the atherothrombotic process" QJ Med 2008; 101:513-518
[4] “TNF-α promotes early atherosclerosis by increasing transcytosis of LDL across endothelial cells: Crosstalk between NF-κB and PPAR-γ” Investigative Ophthalmology & Visual Science, August 1994, Vol. 35, No. 9
[7] A. Malhotra, G. Schofield, RH. Lustig, The science against sugar, alone, is insufficient in tackling the obesity and type 2 diabetes crises – We must also overcome opposition from vested interests, Journal of Insulin Resistance ISSN: (Online) 2519-7533, (Print) 2412-2785 [Link]
[8] Arch Dis Child. 2013 May;98(5):335-40. doi: 10.1136/archdischild-2012-302941. Longitudinal evaluation of milk type consumed and weight status in preschoolers. Scharf RJ1, Demmer RT, DeBoer MD
[9] M. Coelho, T. Oliveira, R. Fernandes, Biochemistry of adipose tissue: an endocrine organ, Arch Med Sci. 2013 Apr 20; 9(2): 191–200. Published online 2013 Feb 10. doi: 10.5114/aoms.2013.33181https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648822/
[10] Hutley L1, Prins JB., Fat as an endocrine organ: relationship to the metabolic syndrome, Am J Med Sci. 2005 Dec;330(6):280-9, [Link]
[11] Harcombe, Z., Baker, J.S., Cooper, S.M., Davies, B.,Sculthorpe, N., DiNicolantonio, J.J., Grace, F. (2015, February 1). Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: A systematic review and meta-analysis. Open Heart, 2(1). Doi: 10.1136/openhrt-2014-000196
[12] Zoë Harcombe and Julien S. Baker, Plant sterols lower cholesterol, but increase risk for coronary heart disease, DOI : 10.3844/ojbsci.2014.167.169, OnLine Journal of Biological Sciences, Volume 14, Issue 3, Pages 167-169, [Link]
[13] Demasi, M., R.H. Lustig, and A. Malhotra, The cholesterol and calorie hypotheses are both dead—it is time to focus on the real culprit: insulin resistance. Pharmaceutical Journal doi, 2017. 10.43.
[13] DuBroff, R., Cholesterol paradox: a correlate does not a surrogate make. BMJ Evidence-Based Medicine, 2017. 22(1): p. 15-19.
[14] Halton, T.L., et al., Low-carbohydrate-diet score and the risk of coronary heart disease in women. New England Journal of Medicine, 2006. 355(19): p. 1991-2002.
[15] Erbel R., Lehmann N., Churzidse S., Rauwolf M., Mahabadi A.A., Möhlenkamp, S., Moebus, S., Bauer, M., Kälsch, H., Budde, T., Montag, M., Schmermund, A., Stang, A., Führer-Sakel, D., Weimar, C., Roggenbuck, U., Dragano, N., Jöckel, K.H., Heinz Nixdorf Recall Study Investigators (2014, November 7). Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study. European Heart Journal, 35 (42):2960-71. Doi: 10.1093/eurheartj/ehu288.
[16] A. Rodriguez-Mateos, G. Istas, L.Boschek, RP Feliciano, C E Mills, Céline Boby, S Gomez-Alonso, D Milenkovic, C Heiss, Circulating anthocyanin metabolites mediate vascular benefits of blueberries: insights from randomized controlled trials, metabolomics, and nutrigenomics, The Journals of Gerontology: Series A, glz047, https://doi.org/10.1093/gerona/glz047
[17] Hambly JL , Francis K , Khan S , Gibbons KS , Walsh WJ , Lambert B , Testa C , Haywood A . , J Child Adolesc Psychopharmacol. 2017 Nov;27(9):823-832. doi: 10.1089/cap.2016.0199. Epub 2017 May 8., Micronutrient Therapy for Violent and Aggressive Male Youth: An Open-Label Trial.