The real cause of heart disease

What is the cause of heart disease? For the past decades the dogma has been that saturated fat and cholesterol are the culprits. But a growing number realize that this outdated idea has been a mistake.

Yesterday Australia’s foremost science television show, Catalyst, broadcasted an episode on the subject. There are many physicians and experts interviewed in the show, and the majority believes that the over-simplified cholesterol theory is simply wrong.

The real cause of heart disease? Inflammation in the artery walls. This may have many causes, but the amount of saturated fat you consume is not one of them. Here are some more probable contributing factors:

  • stress on the artery wall due to high blood pressure
  • high blood sugar levels that damage the cells inside the artery
  • small, dense, oxidized LDL particles that may irritate the artery wall and/or get in between the cells in the wall
  • smoking, which introduces substances to the blood that irritates the arteries

The three first factors are exacerbated by too much sugar and starch in the diet.

In addition to the above: stress. Stress exacerbates all the problems mentioned above – it raises blood pressure, increases blood sugar, worsens blood lipid profile and increases the tendency to adopt bad habits, such as smoking.

Not on the list: butter. Switching to polyunsaturated omega-6-fats won’t be protective either – according to new findings this may even be harmful!

It’s time for more brave experts to stand up and say “I was wrong, you were right”.

So how do you really prevent heart disease? Here’s my best advice:

How to Prevent Heart Disease

  • less sugar (soda, fruit juice, candy)
  • less refined starch (like bread, pasta, junk food)
  • no smoking
  • physical activity in moderation
  • manage stress and get enough sleep
  • eat real food

More Great Health Advice

Four Simple Steps to a Healthier and Leaner Life

Would You Like to Become Smarter, Healthier and Leaner by Putting in Less Effort?


Further interviews with those involved in the show above – and more – available on the show’s homepage

The Death of the Low-Fat Diet

Heart Doctor: Time to Bust the Myth about Saturated fat and Heart Disease

Low Carb Seems to be Healthy In Every Way


  1. Jo tB
    Hi Dr. The link for more information leads to ABC, which is the Australian Broadcasting Commission. = Australian. So it looks like this was aired in Australia and not Canada.

    Still very informative.

    Reply: #3
  2. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    Absolutely. My mistake.
  3. Els ten Napel
    It's seriously cool that science programs are finally starting to give their viewers this information. Way to go Australia! Can't wait to see the next episode, which is about statins.
  4. paulc
    did you like the link I shared with you the other day?

  5. eddy
    Protein raises insulin as well that is why high fat diets in the long run do no better than low carb diets for weight loss after a period of 72 months.

    It is not the glucose that drives the obesity it is the insulin and protein raises insulin as well.
    Protein does not raise the glucose but does raise the insulin.

    Eggs, beef , cheese , lentils, and fish raise the insulin, not as bad as bread and pasta but still raise the insulin levels.

    This from Fung who leans towards a low carb high fat diet and has the diet doctor linked on his web site:
    Trial by diet starts at about 38:00 to about 52:00 at 53:00 he speaks to the importance of eating fat and the role it plays on reducing hunger.

    Whey protein and milk have high impact on insulin . Fiber acts as an antidote and reduce the insulin levels.
    At 54:00 he talks about cortisol the stress hormone and its contribution to weight gain and ways to reduce the cortisol.

    Trial by diet by Fung:

    Reply: #8
  6. Zepp
    Protein rises insulin.. otherwise one cant get amino acids in to your cells.. but it rises glukagon altso.. so your blood sugar dont get rock bottom!

    There are no problems of adeuqate insulin respons to food of any sort.. its hyperinsulinemia thats a problem.. caused by high glycemic load over a long time!

  7. FrankG
    Hmmm... I wonder if that has anything to do with why Dr Andreas advocates an LCHF diet instead of an LCHP diet?!?
  8. murray
    "Protein raises insulin as well that is why high fat diets in the long run do no better than low carb diets for weight loss after a period of 72 months."

    That makes little sense for two reasons. First, low-carb diets are typically high-fat, whether the source of fat is diet or body fat, so there would be no difference after 72 months because they are the same diet.

    I suppose one could have a low-carb diet that is not high-fat, by getting a large percentage of calories from protein--a very high protein diet. I expect a high-fat diet would do better than a very high protein diet, precisely because of the insulin effect of massive amounts of protein.

    I got a glucose/ketone monitor a year or so ago and have verified that I have been in continuous ketosis with high-fat, modest protein, low carb. Ketone levels do indeed go down (indicating raised insulin) and blood sugar up with increased protein, but not until I eat quite a bit of protein. 60 grams of cheese, for example, increases ketones and does not affect blood sugar, so presumably there is no insulin release of significance.

  9. charles grashow
    What are your thoughts regarding high LDL-P?

    "Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL's? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia have inter-cellular gaps and express receptors that facilitate apoB-particle entry. So the worse scenario is to have both high apoB and an inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation: please see Ira Tabas, Kevin Jon Williams, Jan Borén. Subendothelial Lipoprotein Retention as the Initiating Process in Atherosclerosis Update and Therapeutic Implications Circulation. 2007;116:1832-44."

    "So what conclusions do I have regarding patients on low-carb and paleo regimens who show the response of drastically aggravating LDL-C and LDL-P (apoB) together? Every trial, many of them quite large has associated those markers with atherogenesis and CV morbidity and mortality. But some folks are “outliers” and defy that rule. Could the low carb crowd be outliers and in them we can ignore LDL-C and LDL-P? The advocates of those diets say there is no study showing harm of elevated LDL-P and LDL-C in patients who have eliminated or drastically reduced their insulin resistance and inflammatory markers by low carbing. That is true, but what they want to ignore is, that there is no data anywhere that shows they are an exception. Their belief is that by reducing all other atherosclerotic risk factors and normalizing their arterial wall and endothelial biology that, apoB-containing lipoproteins, like LDL, cannot enter the arterial wall. Although LDL-C and LDL-P in plasma are high, none of the cholesterol content of the apoB-particles gains entry into the arterial wall. Is that plausible???? Sure! But is that also erroneous or wishful thinking? Sure? Does one want to bet their CV health or life on a plausible theory? Some do and some do not. Seems to me the first step is to do what this woman did: adjust the nutritional regimen. Now for those who want to live in a ketotic state – ketosis will not happen on this patients regimen, the options are then threefold – (1) stop repeating these measurements, keep your fingers crossed and go about life or (2) reduce saturated fat in the diet to whatever level does not cause cholesterogenesis or (3) start apoB-lowering therapy, specifically statins or statin/ezetimibe depending on absorption/synthesis markers. Sometimes options (2) and (3) are needed together. Statins are not only among the most effective drugs ever created (have saved more lives than anything but antibiotics and vaccines) but are also among the safest. I sometimes get a laugh out of those condemning drugs, especially statins, in favor of some therapy that has little outcome or safety evidence like supplements or various diets. Even diets may have adverse consequences!"

  10. Zepp
    Well its this sort of bogus that inflame the whole debate!

    Cholesterol dont come in to your artery walls by it self.. it needs high numbers of APOb or Glycated LDL, or oxLDL!

    Whats the major cause of high numbers of APOb.. its hyperinsulinemia.. ie, chronicaly high bloodsugar!

    Whats the major cause of high numbers of glycated LDL.. its chronicaly high blood sugar!

    Whats the major cause of oxLDL.. its elevated production of small VLDL.. how is caused of hyperinsulinemia.. how is caused of chronicaly elevated blood sugar!

    Is there other causations?

    Yes there is, but they are rare.. its mostly of FH, patogenes and/or malnutrition!

    And to strating it up.. anything that comes in trugh your artery wall that not supose to be there are probably causing an inflamatory response.. could we agree on that?

  11. FrankG
    While there may be some validity to the position that high numbers of LDL particles is a risk factor _or_ risk indicator (especially the smaller, more easily oxidized phenotype) and disregarding for now, the question as to why their numbers are high in the first place (cause or effect?) we are still left with the oversimplified idea that atherosclerosis starts as a result of an high LDL particle count... in which case, why does it not occur in veins*? Why only arteries?

    *With of course the exception that it DOES occur in veins when they have been surgically transplanted to replace coronary arteries.

  12. Martin
  13. Monique Dalgleish
    Apparently Australia's national broadcaster has been under enormous pressure not to put the second Catalyst program to air. It will be interesting to see how this plays out on Thursday.
    Reply: #15
  14. Zepp
    I could think they do as they do in Sweden.. an expert frome a lobby organisation are comenting in the end?

    And I know what he/she gonna say too.. he is terifyed that people schoul trow away there statins and get an heart atack!

  15. vkool
    Eating too much fat, sugar and fast food is the cause of heart disease. In many cases, people suffer from this disease due to family history. People who suffer from heart disease should be taken care of very carefully.
  16. Robert Pavlick
    Let's face it, as in most medical fields of contention, they really don't know. Much of medicine is trial and error and YOU are the Guinea Pig.

    Most medical commentary is driven by pharmaceutical companies who reward doctors for "pushing their drugs". Health studies paid for by NutraSweet and Stevia, will all tell you that the source of all illness is refined sugar. Health studies done by Smart Balance and Olivio will swear on a Bible that all health and heart problems are due to high cholesterol and trans fats.

    Time was when we were told that margarine was healthier than butter; now it's just the opposite. Then we were told that caffeine was bad for you; now it's the miracle cure for many conditions; undoubtedly due to new studies financed by the coffee industry.

    Likewise,studies done by the beef industry will highlight the dangers of eating farm raised fish and tuna containing mercury. But of course they will not mention the harm done by all of the hormones and antibiotics that saturate their "lean beef". It's all marketing and money. Otherwise, why is it that the FDA approves foods eaten by US citizens that foreign countries will not even allow into their countries ???

  17. bill owen
    I would like to hear more on the statins. I take them as a result from a heart attack 5 years ago....
    Reply: #20
  18. Zepp
    Some benefits frome statins.. not that they are any good drug.. and one can nearly get the same result whit statins that of life style changes!

    One can get up to 0,75% less risk to get a new heart attack!

    Soo.. even as they are proven to prevent some heart attacks.. they just affect the symptomes.

    And there are some indications who have the benefit of it.. its those whit a lot of aterosklerosis caused by elevated APOb.. or a lot of glycated LDL.

    And I hope you are taking your Q10.. its crucial for your cells healt!

  19. erlinda serdenia
    does low density lipoproteins cholesterol contributes cardiovascular disease?
    Reply: #22
  20. Zepp
    Noe its not.. its that if one got FH or some other genetic or metabolic disturbance.. they can accumalte in your blood and get stuck in your artery walls and then forming atheroskleritic placks!

    If those placks bursts, they can get stuck in smaler vessels.. and cause stroke!

  21. Juan Perro de Pastor
    Does the intake {or not} of fats etc. have any effect on syntax, spelling, or the writing of English......or for that matter.....understanding this gibberish?
  22. Balaram Dhotre
    Saturated fats is not the cause of heart disease. Do you really think that after eating saturated fats some of it gets converted into LDL cholesterol? There are numbers of saturated fatty acids. The list is long. But I don't see which particular fatty acids gets converted into LDL cholesterol. If that saturated fatty acid is removed from the fats then preventing heart disease is possible.

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