The cholesterol story: the French paradox, the Swiss paradox, the Russian paradox – where will it end?

When it comes to diet and health, one of my favorite books is “Life Without Bread.” If the title sounds too forbidding, you can relax (at least a bit); based on content, the book should really be named “Life With a Little Bread.”

I like this book because the authors call it as they see it, with no concern for marketing gimmicks or the politically correct. One of the two authors, Austrian physician Wolfgang Lutz, wrote this book after retiring from 40 years in practice. By contrast, many diet and health books today are nothing but self-promotional tools written by individuals with little actual experience to back them up.

Throughout his years in practice, Dr. Lutz meticulously charted the benefits of his carbohydrate-restricted diet on conditions ranging from hormone imbalances in women to digestive disorders and even cardiovascular disease. I am not saying that this diet is a cure-all, but I do think that Dr. Lutz and his co-author Dr. Allan know what theyíre talking about.

When it comes to high cholesterol and heart disease, Dr. Lutz takes the apparently outrageous position that the two are unrelated. He bases this opinion on his review of existing studies, which he holds were misinterpreted to prove a preconceived notion that cholesterol causes heart disease.

A very large ongoing study seems to lend additional credence to Dr. Lutzís view. The study, known by the acronym of MONICA (MONItor Trends in CArdiovascular Disease), is analyzing data from large population groups over long periods of time and in different parts of the world.

Using data released from this study, columnist Dr. Malcolm Kendrick tabulated rates of high cholesterol for various countries and compared them to the prevalence of heart disease in those same countries (see If high cholesterol causes heart disease, then countries where more people have high cholesterol should experience a higher rate of heart disease and vice-versa.

However, the study paints a completely different picture. We have all heard that heart disease is rare in France, a country where high cholesterol is rampant. This apparent contradiction led researchers years ago to talk about a “French Paradox,” explaining that it occurred because the French drink red wine, which supposedly protects from heart disease – a theory that was never proven but that I am sure the wine industry loves.

But if there is a French paradox, this study has also uncovered a Swiss paradox. Switzerland actually has an even greater incidence of high cholesterol among its population and an even lower rate of heart disease than France. At the other end of the spectrum, the study found a Russian paradox, since Russia has the highest rate of heart disease of all the countries analyzed but the third-lowest rate of high cholesterol.

The MONICA study is actually finding that both high cholesterol and low cholesterol are equally compatible with high and low rates of heart disease. I think Dr. Lutz might have a point.

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