Regarding minerals, the calcium-magnesium interchange and the sodium-potassium relationship affect hardening of the arteries and blood pressure. Even copper and zinc deficiencies and imbalance may be related. It is clear however, that the saturated fats and cholesterol in the diet are linked to CVD in all animals studied, including the human species. Carnivorous animals, such as dogs and cats, seem relatively immune to high-fat diets. Possibly understanding their protection will give us further insight into CVD prevention.

The relationship of cholesterol has been and continues to be the biggest controversy in this area. Current thinking is that high blood cholesterol, especially with higher LDL cholesterol (the "bad" kind) and lower HDL cholesterol (the "good" kind, because it picks up used cholesterol and carries it back to the liver), is a significant factor correlated with atherosclerosis, coronary artery disease, and early death. The very large Framingham study showed that people with a blood cholesterol level of 260 mg. had three times the incidence of myocardial infarctions that those with levels of 195. Lowering cholesterol levels by whatever means?diet, weight loss, exercise, and even drugs?decreased the risk of heart attacks. Yet there may be other variables; this cholesterol picture may just be the surface factor.

Some authors, such as Richard Kunin, M.D. and Michael Lesser, M.D., feel that the metabolism of cholesterol, which uses many vital nutrients, is the real problem. With adequate nutrient levels, reasonable amounts of dietary cholesterol will not cause the problems we are seeing. Our liver makes cholesterol, which we need for many functions such as the production of hormones (estrogen and testosterone), vitamin D, and bile. A natural feedback mechanism should reduce our production when we consume cholesterol-containing foods. There may be certain factors, yet unknown but possibly genetic and nutritional, that interfere with this feedback mechanism. B vitamins, vitamins C and E, magnesium, manganese, and zinc are all needed for cholesterol metabolism, and if these are low, this waxy fat cannot as easily get into the cells to function and sludges around in the blood, clogging up our vessels. This is rather like the process in adult diabetes, where the sugar cannot get into the cells and stays in the blood, causing problems.

In Mega Nutrition, Dr. Kunin suggests that the rapid rise in CVD was associated with three important dietary changes besides an increase in fat intake that were as significant as or even more significant than cholesterol. First was the refining and milling of flour which removed many of the nutrients that are important to cholesterol metabolism. Second was the use of chlorinated water which was popularized and spread throughout the country. Chlorine tends to bind and reduce levels of vitamin E which acts as an important protector of the vascular lining. Third, homogenized milk also hit in the 1940s. Homogenization changes the fat composition of milk so that it is not as easily metabolized and passes more readily through the liver. This, I believe, is a big factor in the increase in CVD.

These theories have some backing, but are not generally accepted. More research is needed to verify that we can still eat a reasonable amount of high-fat and high-cholesterol foods such as eggs, meats, milk, and butter, and still not develop CVD, as long as our diet is nutrient-rich and meets all of our needs. Until then, I believe that there is more than enough research evidence to prove that eating a diet low in fat, especially saturated fat, and cholesterol, along with the other changes that I suggest, is still the best thing to do. We still need fats in our diet, but mainly the natural essential fatty acids found in nuts and seeds, fish, and grains and beans. These oils are necessary for many vital functions and also help release bile products from the liver and gallbladder. Bile is made from cholesterol and thus is one of the ways to eliminate cholesterol from the body.