Heart Disease – The Towering Inferno!
Cholesterol – A Phoenix from the Flames.
In an earlier blog I asked the question is type 2 diabetes the medical Hillsborough?
Which got me thinking about another football disaster I witnessed as I was growing up in the 1980s. The fire at Bradford City, which killed 56 supporters (54 Bradford and 2 Lincoln City) and injured at least 265 more.
It was meant to be a day of celebration, the day they were crowned as champions of league division 3, receiving the trophy on the pitch before the game. Less than an hour later one side of the old wooden grandstand at Valley Parade was alight and fans were scrambling onto the pitch with their clothes on fire. Fellow supporters and police officers jumped on top of the victims in a desperate effort to douse out the flames.
I remember watching those scenes live on Grandstand, not really comprehending the enormity of the tragedy at the time. It was only when the official death toll was announced that the true horror hit home and I recalled the words of John Helm, commentating for Yorkshire TV:
“People are panicking, frantic to get out…. this is a burning hell.”
The official narrative, according to Detective Ray Falconer, was that a man from Australia had tried to put out a cigarette stub with his foot, but it fell through the wooden floorboards onto a pile of rubbish underneath the main stand.
Ironically, years later this same detective would be involved in one of the gravest miscarriages of justice this country has ever seen, the Carol Wilkinson murder case, in which an innocent man was jailed for 20 years.
It took less then four minutes for the whole terrace to be engulfed in flames, which spread “faster than a man could run,” and for plumes of thick black smoke to cover the pitch and reach one hundred yards into the afternoon sky.
The structure of the antiquated stadium consisted of a 77 year old wooden roof, covered with highly flammable bituminous felt, a dilapidated timber frame in the last throes of life, this was the proverbial accident waiting to happen.
Warnings letters had been sent to the club in the preceding years by the council and the fire service, but the club couldn’t afford to make the changes required and instead the stand was officially condemned, awaiting demolition, whilst the safety of the fans was ignored.
Another factor which also played a major role in the catastrophe was the surrounding environment.
Just two feet beneath the stand, a chronic build up of rubbish had formed, years of litter dropped by unsuspecting and careless spectators, had unwittingly created the conditions for inflammation/combustion and the club had neglected to clear it up. A charred copy of the local newspaper from Monday, 4 November 1968, was even found amongst the debris after the fire.
The inevitable inquiry was held a few weeks later by Sir Oliver Popplewell, five days of testimony, a 27-page report, a ban on new wooden grandstands and smoking inside existing ones and that was that – move along, nothing else to see here!
Except, in the eyes of one man, there was a lot left to see.
Martin Fletcher was at the ground that day, he was also at Hillsborough. Just 12 years old, he was accompanied by his 34 year old father, John,11 year old brother, Andrew, uncle Peter, 32, and grandfather Eddie, 63, Martin was the only one of them to survive.
In his book: Fifty-Six: The Story of the Bradford Fire. Martin set out to unearth the “truth” about the disaster, spurned on by the words of his mother:
“ Maybe you’re here for a reason.”
He sought to put the record straight, not only for his own family, but for the families of all the people who died around him.
Fletcher, became determined to challenge the accepted theory, that the fire had been started accidentally by a stray cigarette butt. He devoted himself to extensively investigating how the disaster was caused, the culture of institutional neglect and the government’s general indifference towards football fans’ at the time.
He discovered that the Bradford Chairman, who died in 1995 at the age of 61, had been connected to at least eight other blazes at business premises and insurance claims around the area. Mere coincidence, perhaps, but when you are linked to so many similar disasters, a few alarm bells and questions deserve to be answered.
Questions, such as:
How did it start?
Why did it spread?
Were there alarm signals?
Was the response adequate?
What are the implications and lessons to be learnt
When he started to analyse these questions, Fletcher concluded that Bradford was indeed a disaster born out of neglect, the use of inappropriate building materials, a lack of safety equipment (fire extinguishers had been removed from the terraces due to vandalism), inadequate rescue equipment, and a poor local environment (rubbish).
Fast forward 32 years, and what lessons have been learnt?
Well, judging by the Grenfell Tower catastrophe, very few.
The same mistakes and the same unanswered questions are left for another forth coming enquiry.
Both Bradford and Grenfell were human tragedies, but what is the relevance to heart disease you may ask?
Well, I can remember watching a 1970s film called: The Towering Inferno, starring Paul Newman and Steve McQueen, in which the McQueen character says:
“The body count was only 200, one of these days 10,000 people are going to die in one of these fire traps”
Today feels like one of those days, only I’m not referring to a tower block or a football ground, but the inflamed terraces of the arterial walls. The structure of chronic heart disease which is the scene of the leading cause of mortality in western society.
And, just like Martin Fletcher, I feel a sense of justice and duty of care to my patients, to start asking a few questions of the perceived wisdom that cholesterol is responsible for so many of these untimely deaths.
It is often said of the medical profession that we are very good at fighting fires, but absolutely hopeless at preventing them or recognising the root cause. Where’s the fun in that or indeed the money!
We’ve worn our firefighters badges with pride for far too long and are not going to give them up without a struggle. But, in the words of Nobel prize winning Mr Zimmerman, the times they are a changin’ and some of us are moving over into the fire prevention/investigation department, in the hope we can find some worthwhile answers and make a real difference.
I suspect/hope, heart disease and its prime suspect cholesterol is going to be one of the first cases to be solved.
To be fair, there have been a number of eminent doctors questioning the existing dogma of cholesterol and heart disease for many years now, Dr Malcolm Kendrick (The Great Cholesterol Con) and Uffe Ravnskov, (The Cholesterol Myths), being the most notable.
And yet, the myths surrounding cholesterol are as intransigent as the prevailing football myths of scoring too early, and home field advantage (both untrue).
The simple narrative has been; it clogs up the arteries and therefore high levels are bad for you and cause heart disease, along with the whole eat fat and get fat diatribe.
Except, if you look at the actual data, rather than the media driven hype, you get a completely different story of what is going on.
But then, they do say dead men tell no tales, doctors bury their mistakes, architects cover theirs in ivy, and when it comes to research scientists, you get papers that never see the light of day or are hidden from sight, behind gargantuan pay walls never to be read by disconcerting eyes.
Or, in the case of cholesterol, you have the Cholesterol Triallists Treatment Collaboration (CTT) based in Oxford, withholding all the clinical trial data relating to statin medications.
So, in the interests of fair play, here are a few studies that may have been caught offside without your notice.
1. A study reported in the Journal of the American Medical Association way back in 1982, showed that decreasing the saturated fat consumption of 361,662 men by 28% produced no beneficial effect on the incidence of coronary heart disease or total mortality.
2. A review in the British Medical Journal in 2001 concluded that: “Despite decades of effort and many thousands of people randomised, there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality.”
3. A Swedish paper published in the Journal of Internal Medicine in 2005, looked at over 30,000 people in a six year period. The conclusion was that: “Saturated fat showed no relationship with cardiovascular disease in men. In women, cardiovascular mortality showed a downward trend with increased saturated fat intake.”
4. The Women’s Health Iniative, the largest randomized controlled trial on diet in history, involving 48.835 postmenopausal women for more than 8 years, concluded in 2006, that the consumption of saturated fat had no effect on heart disease, stroke, total mortality or cancer and diets low in saturated did not reduce the risk.
And finally, the most recent study.
5. The PURE study published in the Lancet 2017, followed over 135 000 people in 18 countries for over seven years. They found that people who ate more carbohydrates died earlier. A higher intake of fat, on the other hand, was linked to longer lives.
When you start asking questions, reviewing the evidence and delving a little deeper, as any fire investigator worthy of their salt should do, you do indeed, get a quite different story.
A story that began in the 1950s, with Dr Ancel Keys, with his doctorate in oceanography, who postulated a correlation between cholesterol and CHD, based merely upon his own observation that well-fed executive fat cats had high rates of heart disease.
This led to his now infamous: Seven Countries Study, which conveniently omitted data from 15 of the 22 selected countries, in order to show a direct linear relationship between the two existed.
Some may say this was fraudulent, others may call it cherry picking, I prefer to use the analogy of Dante’s Inferno, 9 Circles of Hell, to emphasise its disastrous consequences.
From this single exercise in data manipulation, we demonised cholesterol, devised deadly dietary guidelines, produced massively profitable, largely unnecessary drugs and saw the creation of a highly processed low fat foods industry and a dramatic boom in obesity
A feat of which, Beelzebub himself would have been mightily proud!
And what of the blazing structure itself – the human body, transformed through millions of years of evolutionary pressures to produce the current working model. A multitude of safety mechanisms, feedback loops and communication networks, all designed to withstand whatever nature cared to throw its way.
Surely, it wouldn’t be so careless as to allow cholesterol to destroy its masterpiece?
It just doesn’t make sense, a compound that is produced by the liver, which every single cell membrane in the body contains and 25% of it is found in the brain, is it really going to cause such devastation?!
It is a vital building material for structural health and yet most of us have been led to believe it is indirectly responsible for the biggest killer on the planet (CHD), an arsonist of legendary proportions, scorching the arteries with its venomous breath.
No wonder we seek to lock it up and throw away the key to cholesterol synthesis with our mighty statin medications.
If this were really the case however, why don’t these cholesterol lowering drugs prevent more deaths? Why is there no correlation between reducing cholesterol and heart attacks? Why do statins cause so many side-effects. Why does having low cholesterol increase mortality?
So many questions unanswered, and yet the the only answer we seem to have come up with so far, is to prescribe more of the bloody things, in the vain hope if we get the numbers low enough we’ll eventually hit the jackpot.
C’mon, c’mon, roll up, roll up, buy your lucky cholesterol ticket here everyday for the rest of your life, one winner for every 98 entrants, all proceeds go to a wealthy cause. Though don’t forget to read the small print on the back: May cause, diabetes, muscle breakdown and death!
And don’t think for one minute I am allowing my poetic license to muddy the waters, those really are the scores on those increasingly darkened doors.
Wouldn’t it make much more sense, at least in evolutionary terms, for cholesterol to be helping to put out the fires and repairing the damage?
A firefighter rather than a fire starter, and that’s the real reason it’s found at the scene of the crime.
After all, it is the hero in this odyssey, an epic voyage traversing the fast flowing seas of the human body, picking up important passengers (fat soluble vitamins) along the way, testing the waters, slaying the enemies (free radicals), before a final triumphant homecoming back to its metabolic origins in the land of the liver.
For every Hero, however, there must also be a villain, enter stage right: Insulin Resistance.
A persistent foe, with fiery breath, that leaves its victim, drained of life, bereft of ideas, hungry for food and yet still full of fat. A beast hidden away in the catacombs of the body, smouldering, festering on its structural integrity, until eventually the aging body succumbs, and heart disease, diabetes, dementia, arthritis and cancer ensue – a metabolic disaster of Herculean proportions.
Enough of this infernal hell I hear you cry, back to more worldly matters and our much more mundane fire investigations!
How did the fire start?
Well, I think we can safely rule out cholesterol as a suspect – why would the body spawn its own fire-starter?!
A fire requires 3 essential ingredients: Oxygen, fuel and heat.
Nobody knows for sure how heart disease develops, it is highly likely multifactorial,
but, we do know all 3 components play a role.
Oxygen: In the form of highly volatile free radicals which place a stress on the structure of the arterial walls.
Fuel: In the shape of glucose and triglycerides, too much of either and you are a fire risk. In the average diet, as recommended by the dietary guidelines (60% carb, 20% fat and 20% protein), the vast majority come from carbohydrates.
Heat: Anything that causes stress could be said to generate ‘heat’. For example, a heated argument is stressful for those involved, perhaps, this is why type ‘A’ personalities are more prone to heart disease or why type ‘D’ (distressed and depressed) people have worse outcomes after a coronary event.
At the cellular level, if you are continually stressing the body with a poor diet, lack of sleep, smoking and other pollutants, you will inevitably be triggering some form of inflammatory response.
In terms of metabolism, the end result of such persistence is usually insulin resistance. The terraces of the cells are filled to capacity, causing highly combustible fuel to spill out – thereby greatly increasing the risk of fire.
In other words, by eating excessive carbohydrates over a prolonged period of time and not burning them off through exercise, the beta cells of the pancreas become exhausted and dysfunctional and the fat cells become over crowded and inflamed, and finally resistant to the actions of both insulin and its partner in crime, glucagon.
Combine all 3 elements together and you have exactly the right environmental conditions for a fire!
2. Why did the fire spread?
One word – Cladding!
In an effort to reduce costs and still look attractive, the food industry manufactured its very own dietary version of “cladding.” Artificial low fat products, filled to the rafters with inflammatory refined carbohydrates. More economical and profitable for the food companies perhaps, but hardly fit for purpose?
If you’re eating 500 calories of something and you’re still hungry in an hours time, that isn’t food. Not proper nourishing food anyway, which builds your body and strengthens your immune system. No, that’s cheap highly processed synthetic cladding, which might look and taste great, but ultimately it’s going to leave your defences exposed and vulnerable to attack.
It fans the fires of appetite and feeds the flames of inflammation, with disastrous consequences!
3. Were there adequate alarm signals?
As previously mentioned the body is a well designed structure, it does indeed have the equivalent of smoke detectors, alarms and fire extinguishers, it’s called the immune system. The problem arises when you keep setting it off, by eating too many highly processed foods and then fail to answer the distress signals of obesity, high blood pressure and insulin resistance.
That’s when the fires begin, and unless you act promptly and effectively the fire will spread.
4. Was the advice given correct?
In the case of the Grenfell Tower fire, the advice for residents to stay put, had deadly consequences. Likewise at Hillsborough, the order to open the gates led to many more deaths. You see the advice of so-called experts is not always correct, in fact, it’s very often completely wrong.
The dietary guidelines to eat less fat, and reduce cholesterol, follows a similar deleterious path.
For although the figures show we have been very good at adhering to those guidelines, the actual results have been shocking. Two thirds of adults overweight, a doubling of diabetes in the last 20 years and cancer rates soaring.
When are we going to realise the supposedly healthy eating advice, so many of us try to follow, is simply not working and is merely fuelling the insulin resistant fires.
And, if we continue to stay on our high carb diets, wait for the studies, wait for the drug companies, wait for the food industry and wait for the guidelines to catch-up,
we may be waiting for a very long time. By which time the towering inferno will be well and truly ablaze and all escape routes completely blocked.
You see, time may be a great teacher, but unfortunately it kills all its pupils.
Indeed, the eat heart healthy whole grains and avoid saturated fats like the plague advice, is, I expect, going to be this generation’s;
“four out of five doctors recommend smoking Camels (cigarettes)”
5. Was the response from the emergency services adequate?
The past 20 or so years has seen the emergence of big block buster drugs, and Lipitor ( Atorvastatin) has been the clear headline act, grossing over $131bn and $10bn annually at the box-office.
For that sort of money you’d expect some kind of bang for your buck or at least a fire-stopping performance, saving millions of lives.
Unfortunately, the action is more style over substance. Yes, the figures are good (in terms of lowering cholesterol), but the overall results are rather disappointing. The studios may claim rave reviews, like reducing heart attacks by 33%. However, when you actually ask the film goers about their own experience, you get a quite different picture.
An absolute risk reduction of just 0.4% in patients with no vascular disease.
A numbers needed to treat (NNT) figure of nearly 500 people a year to prevent one vascular event.
14% of patients reporting side-effects such as; impotence, cognitive deficit, insomnia, fatigue, and musculoskeletal soreness.
A 33% increased risk of diabetes.
and, for the vast majority of patients,
0% increase in life span!
Correct me if I’m wrong, but that’s hardly a good return on investment!
Alas, the medications we use today to put out the flames of chronic diseases are like the ladders at Grenfel only reaching the 10th floor; they are very expensive and in many cases entirely ineffective.
6. What are the implications and lessons to be learnt?
Clearly, the main focus should be on each of these 3 key areas:
Reducing stress (oxidative, and psychological)
Controlling and mobilising fuel supplies (fats and carbs)
Turning down the heat of inflammation (insulin and glucagon resistance)
In this respect the following recommendations are made:
A radical rethink on the dietary guidelines, to ensure the bodily structures are built with high quality materials (food) and are well maintained (exercise)
Alarm signals should be acted upon not just switched off with medications.
The response of the medical profession needs to shift to finding the source of each individual fire and putting it out with lifestyle modifications, instead of attempting expensive long term medication control.
The surrounding (cellular) environment should be kept clean and the social environment should be positive, encouraging a caring society, with an emphasis on stress reduction.
Overall responsibility for each human structure should remain with the individual.
The allocation of a responsible Fire officer is advisable and regular fire drills are
important to ensure an effective action plan is in place in the event of a fire.
Fires don’t just happen, the vast majority are not due to spontaneous combustion
or genetic inheritance. They happen for a reason and until we address that, they
will keep happening.
So there you go, another fire investigation completed, time to take stock and reflect upon the purpose of this noble endeavour, and ultimately that can only mean one thing:
Prevention – with a capital “P”.
I have lost count of the number of patients succumbing to the raging infernos of metabolic diseases in my medical career, or the venomous heads of hydra spewing out the myth of cholesterol and heart disease, despite striking evidence to the contrary.
Fire investigators in the 1980s were known as “dust kickers,” because of the lack of forensic evidence available to them, my fear is we are now becoming “dusk gatherers” because we have so much evidence exonerating cholesterol and yet most of us are choosing to ignore it. Safe in the knowledge that following the precious guidelines will protect us.
Except this miscarriage of justice is simply not acceptable anymore, not whilst people are dying on the burning pyres of insulin resistance and we have the resources to dampen out the flames.
No longer can we afford to wait and witness our sacred health systems being burnt to the ground by the arsonists of chronic disease.
Now is the time to stand up and shout: “Fa-fa-fa-fire!” as loud as we possibly can.
This is a rage against medical science’s breathtaking complacency: The same sort of complacency that led to the fire at Valley parade and turned the terraces of Hillsborough into the killing fields of Sheffield, four years later.
A society which puts profits above people’s lives, reputations above all else and the advice given by the experts actually makes the situation worse.
The Hillsborough disaster and Bradford City fire in the Eighties, led to fundamental changes in the design of football grounds. No doubt Grenfell will see similar developments in tower block safety.
However, if any good is to come out of the cholesterol tragedy, let it be lasting improvements to people’s health. Let us extinguish the fires of insulin resistance once and for all, through the use of effective building materials (unprocessed foods low in carbs and high in healthy fats), the adoption of adequate safety mechanisms (exercise and relaxation, stress reduction), the use of reliable rescue equipment (sleep and sun) and by ensuring a relatively clean, rubbish free environment (fasting and autophagy).
Only then can cholesterol rise from the ashes like the mythical bird with fiery plumage, renewed and reborn as a defender, not an attacker, and then we must forgive ourselves for not having the foresight to recognise what was so obvious in hindsight.
The cholesterol inferno may have taken us to hell and back, through the depths of despair and human misery, but remember;
“the first one now will later be last, for the times they are a-changin’”.
Bob Dylan – The times they are a changin’:
“Soon you will be where your own eyes will see the source and cause and give you their own answer to the mystery.” Dante Alighieri, Inferno.
Play Well, Get your Teams in Shape and Take Care!
Scouting Report: Dr Malcolm Kendrick