Fundamentals of Chronic Disease

Most of the chronic diseases that plague modern western civilization were rare or undescribed less than 150 years ago. What we consider normal aging is anything but from the perspective of human history. This doesn’t mean that we aren’t better off than our ancestors, mostly we are, but they suffered other issues that we have largely solved and we suffer from diseases they never dealt with.

The most common cause of chronic disease today is atherosclerosis, the process where cholesterol plaques are laid down in arteries. These plaques reduce blood flow passively, all the time, and when they become unstable they can rupture and create a sudden blood clot that blocks all the blood flow to an area of the body. In most places this is not serious, but when it happens to the heart or brain it can be an emergency.

New research is showing that these events happen more often than we used to believe and it is only the most severe that even give us discernible symptoms. In fact, up to two thirds of the events that damage the heart muscle and brain go undetected.

So what is the best solution to this major, major problem? This is the most common cause of death in the world now.

The European Atherosclerosis Society recently met to discuss this problem and they came to a consensus about what to do. Their method was interesting. They surveyed the entire medical literature to look for eight different characteristics that allow us to say that one thing causes a specific disease*.

Their conclusion: LDL cholesterol is a cause of atherosclerosis. It may or may not be the only cause, but it is a cause.

Their solution? More pills and shots.

Yes, that’s right. Not a mention of shifting global dietary patterns in the entire paper. When you hit Ctrl-F and type in diet you get a zero.

Now to be clear, they do reference many studies looking at diet and LDL cholesterol. There are 395 metabolic ward studies that show that saturated fat and dietary cholesterol raise LDL cholesterol.

There are multiple studies that show added refined sugars also raise LDL cholesterol.

So here we are. We know the cause of elevated LDL cholesterol – sugar, saturated fat and cholesterol in the diet. We know that diets that are high in complex carbohydrates, fruits and vegetables and low in sugar, saturated fat and cholesterol reliably lower LDL cholesterol.

This is not incredibly complex, although some try to make it seem that way. They point out that everybody has LDL and so it can’t cause disease, ignoring the idea of a gradient present in the article. Just as water can give life or cause drowning, too much of almost any substance can cause disease.

The solution is a switch on a personal level by people affected by the disease. Family, friends and co-workers need to adopt the habits that will keep those of us already affected alive. It will also prevent those of us not affected from becoming ill. This is the only way that the population can change. When populations change the results can be astounding!

In the 1960s, the Finnish province of North Karelia, had some of the highest death rates from coronary heart disease in the world. This chart shows the 82% decrease in deaths (mortality rate per 100k) after the government mounted an aggressive campaign to improve diet, decrease smoking, and increase exercise in the population.

Atherosclerosis is causative of stroke, ischemic heart disease, dementia and many other common conditions. When we use healthy food and lifestyle to drop LDL, the benefits can be enormous. Drugs, pills and shots should be a last resort when all that has failed, not the first choice.

*Those characteristics are plausibility, strength, biological gradient, temporal sequence, consistency, specificity, coherence and reduction of risk with treatment.

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