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The Role of Cholesterol and Excess Fat in Disease

By Milton G. Crane, M.D. and Barbara G. Crane, R.D. of Weimar Institute

What would you do if you were a doctor and knew of a situation that was causing premature death in over half of your patients? What would you do if you knew of this, and also knew what the cure was? These questions introduce the portrayal of how dietary cholesterol and excess fat can cause degenerative arterial disease. When one looks around in the field of medicine, he sees many ailments that fall in the realm of preventable diseases.

One hundred fifty years ago anesthetics were not used; the nursing profession, as we know it, did not exist. One hundred years ago doctors did not use masks or rubber gloves during surgery. Pneumonia, influenza, gastroenteritis, tuberculosis, and other infections, caused over half the deaths and these would be considered preventable deaths with our present medical capabilities. The use of antibiotics, vaccines, and the advent of scientific medicine have reshaped the entire health world. While all this progress has been going on in the realm of medicine, there have also been changes in food technology and power gadgets to our detriment. And now we can see what the consequences are of our faulty life style. In our time, we suffer from preventable diseases of a different order. We suffer premature deaths from heart attacks, strokes, high blood pressure, and cancer. In addition to these, many more of our non-fatal medical ailments can be traced to a faulty diet and a sedentary life style.1,2,3 Ailments, such as degenerative arthritis, herniated discs, hemorrhoids, diverticulosis of the colon, may cause discomfort and pain, but they are not serious enough to cause death.

Of the dietary factors that cause these degenerative diseases, we can name two that are the main culprits - animal products and refined foods. Most animal products such as flesh foods, milk, and eggs are high in fat, contain variable quantities of cholesterol, are low in carbohydrate, and have no fiber. This is just the opposite of the contents of plant products. Most nutritionists have no trouble recognizing the deleterious effects of refined sugar and refined cereals on our health. For many of them, though, this concern against empty calories does not seem to extend to the refined fats such as oil, margarine, and shortening. But let us look at the potential role of excess fat in disease states and try to fathom how the harm is done.

Cholesterol

First of all, let us take a look at cholesterol. It has been studied and maligned over the past 30 years more than any other one thing in arterial disease. Chemists say that cholesterol is a phenanthrene ring of carbon with some hydrogen and oxygen atoms. As one young student described it, it is dihydroxy, dimethyl chicken wire as we can see from its shape. Cholesterol is important in the body, but almost every cell in the body can make it. Cholesterol is used for insulation of the nerve fibers. That is why it is so high in brain tissue and in the egg yolk. The irradiation of cholesterol in the skin by sunlight produces our Vitamin D. It is the basic material for the formation of adrenal hormones and male and female hormones. Most of the cholesterol that is made in the body is for the purpose of handling fat. It is the source of bile salts, the soap in the digestive tract, for the digestion of fat in the food. The intestines make it to assimilate fat.

Liver

When we put fat in the mouth, a signal from inside the mouth or stomach tells the liver, "Hey, here comes some greasy oily stuff. Get ready; make some soap." The liver takes a two carbon atoms complex called "acetate" and makes the entire chemical ring of cholesterol. In fact, as you are reading this your liver is making 50 quintillion molecules of cholesterol per second. That is 50 with 15 zeros behind it. About 70 % of this cholesterol is converted into bile salts which are the emulsifying agents.4 These go down the bile duct into the small bowel. The stomach has a valve which lets the food out into the duodenum a little at a time as sufficient bile salts are available to emulsify (water suspend) the fat coming into the small bowel.

The gallbladder works as a holding pocket for the bile that is made between meals. While the bile is in the gallbladder, it is concentrated about four-fold. If we snack between meals, we may not have this highly concentrated bile for use at mealtime. The liver, then, has to make more at mealtime, and digestion takes a little longer.

At any rate, as we follow the digestion of the food from the stomach down the digestive tract, we notice that all of the fat has to be emulsified to keep it from being oily or greasy so that the enzymes can digest the protein and starch as well as get at the fat itself to digest it. As the emulsified fat moves along the intestines, it is disassembled into its components of fatty acids and glycerol. These are absorbed by the intestinal wall and rehooked up in the form that our own body wants them and made up into little balls of fat called chylomicrons and VLDL particles. These enter the circulation and make their way in the blood to the liver. There the big ones, the chylomicrons, are screened out and made into small balls called low density lipoprotein (LDL) particles. These are "cell food" and consist of triglycerides, cholesterol, phospholipids, and protein designed in such a way that the cells can use them for their protein, fat, and lecithin needs.

As the LDL balls float along in the blood stream, they come to an artery that needs some of them for food. You see, the artery is a very hard working organ. Every time the pulse wave comes down from the heart, the artery dilates under the pressure. It must then contract down by muscle power and elastic recoil to its original size. The muscle and elastic cells deeper in the wall of the artery send signals to the little endothelial cells that make up the inside lining of the artery when they need some LDL or VLDL to eat. These endothelial lining cells open a hole and let some of these little LDL food particles go through the artery wall to the hungry muscle cells.

The muscle cells and elastic cells in the artery wall eat the LDL particles by engulfing them. They use up the protein, the phospholipid, and the triglyceride. Guess what is left over! You are right, cholesterol. This left over cholesterol is supposed to send a signal to the cells and back to the liver when it gets too high, but in some patients this signaling device does not work as it should. Consequently, some people make much more cholesterol than they should. Furthermore, far too many LDL particles may get forced through the holes in the arteries if the blood pressure is too high, or if there are much too many LDL particles in the blood as happens after a fatty meal, or if tobacco poisons get down to the artery lining and paralyze these endothelial cells.

At any rate, this left over cholesterol accumulates inside the cells and forms little crystals inside the cells. These little crystals are very irritating to the cells. With each pulse wave, they are bent a little on the inside of the cells. All the evidence indicates that they have piezoelectric properties. Day after day, with each pulse wave these little crystals of cholesterol act like grains-of-sand inside the cells.5

Some of the cells may swell up, sicken, and die. They form a boil-like plug on the inside of the artery. Some cells respond by putting up a wall of firm fibrous scar tissue and even bone-like calcium around those irritating little crystals. It has been shown that if animals are fed peanut oil with cholesterol, they develop fibrosis of the artery wall.6-8 The artery wall gets thicker and stiffer. On the other hand, if animals are fed coconut oil with the cholesterol, they developed atheramas, the swelling lesions on the inside of the arteries.6-8

The good news is that this extra cholesterol can be removed. God has built into this system a way to haul out this extra cholesterol. The system that does this is called HDL-cholesterol. HDL is a high density lipoprotein ball of fatty material which goes to the cell, hooks onto the cholesterol, and takes it back to the liver. After the liver releases the cholesterol from the HDL particle, it goes back for more. The cholesterol goes out into the bile ducts to the small intestines.9

Of the three forms of HDL, HDL2 is the best kind to remove cholesterol. Exercise (but not alcohol) is the prime factor to raise HDL2 blood level.10,11

If there is too much cholesterol for the bile salts to keep it in solution, gallstones may develop as the gallbladder concentrates the bile. These stones continue to grow so long as we continue to eat a faulty diet.

How does this extra cholesterol that is dumped in the intestines get out of the body? It rides out in the colon on plant fiber and sterols. You see, the cholesterol molecule, the phenanthrene ring, cannot be broken down by the body, it has to be eliminated by the gut. If we eat a high fat diet, a low fiber diet, or a low plant sterol diet, far too much of the cholesterol will be reabsorbed by the small intestines into the blood stream.

So long as we subsist on a low fiber, high fat diet, the total amount of cholesterol will gradually build up in the body over the years. It will accumulate mainly in the arteries and the gallbladder, but also in the cell walls. Our goal is to reverse that process. We advocate (1) a low fat diet so that the person will make only minimal amounts of cholesterol in the liver and intestines, (2) avoidance of the foods that contain cholesterol from the diet, and (3) a high fiber diet so that there will be a high elimination of cholesterol from the body, and (4) exercise to raise the level of the good HDL.

None of the foods that we serve in the Weimar NEWSTART Center have cholesterol in them. We serve no meat, fish, fowl, eggs, or milk fats. Furthermore, we restrict the refined foods such as oil, margarine, shortening, sugar, and starch from the diet because they have no fiber. We restrict the white flour and white rice, and canned fruit iuice because most of the fiber has been removed from them. Patients who have coronary heart disease, high blood pressure, diabetes, a weight control problem, and degenerative arthritis are advised to avoid the natural high fat foods such as nuts, olives, avocados, soybean products, and the high fat seeds even though they have natural fiber because we do not yet know how the naturally high fat foods will affect the removal of cholesterol from the body. We call this our "therapeutic" diet.

With time, we may in modest amounts, but at the present time our success is too good to jeopardize the benefit that we are getting with our therapeutic diet. After the really sick ones have recovered their health so that their blood pressure is down, their body weight is in the optimal range, and their cholesterol is at its nadir, they can try adding these foods that are naturally high in fat to the diet. If they do, they should follow their blood cholesterol. If the cholesterol goes back up, then they know what they must change in the diet.

The usual cholesterol level of aborigines (who do not get atherosclerosis) averages 150 mg% (range 100 to 180 mg%). Our patients should aim for the same, - a level of about 150 with a Cholesterol/HDL ratio below 3.5. We can find out what each person's ideal level is by measuring their blood level after they have been on a good therapeutic diet for two to three months. Usually by that time the serum cholesterol has dropped as far as it will go by diet alone. Those with a continued high ratio may need additional help.

Oil

Now let us consider oil in the diet. Oil that we usually get in the diet comes in different chain lengths. They may be 12, 14, 16, 18, or 20 carbons atoms in the chain hooked together with a single or a double bond between them. Two oxygen atoms are linked on one end. Wherever there is a single bond between the carbons, there are two hydrogens
also hooked up directly opposite from each other. Wherever there is a double bond, only one hydrogen is hooked on to the carbon. When there is only one hydrogen present with a double bond between the carbons, the chain takes a 60 degree turn at each of the two carbons. If the hydrogens project in the same direction from the carbons at the double bond, this is called a “cis" arrangment and causes a 120 degree "U"-shaped turn in the chain. If the hydrogens project in the opposite directions, they make a jagged "Z-shaped offset in the chain, called a "trans" arrangement.12,13

CIS-Form

These sizes and shapes are important because the cells look for certain shaped fatty acids when they want building blocks for cell membranes or for raw materials to make some very important chemicals for the body. There are four families of chemicals that the body makes from fats: prostaglandins, thromboxanes, leukotrienes, and hydroxy-fats. The fatty acids that have no double bonds have straight chains. These are called "saturated fats" because there is no further room for hydrogen to be hooked on the carbon chain.

Alpha-linoleic acid (Omega-3)

This chemistry is a bit deep, but it is very important. What the body is looking for is an essential fatty acid which has two or three double bonds in the "cis" arrangement with the double bonds located at precise locations 6=7 and 9=10, or 3=4, 6=7, and 9=10 carbons from the methyl end. With these fats, the body chemistry can make a set of prostaglandins and thromboxanes that cause the arteries to relax and dilate and produce platelets that have just the right stickiness. If the first of the three double bond is located six spaces from the methyl end of the chain, the body chemistry makes a set of chemicals that cause the arteries to constrict and platelets which are too sticky. These cause the blood to clot too easily.

Fats as we eat them come as triglycerides with three fattv acids hooked up with glycerine. There are some fatty acids that cannot be made by the body. These are called "essential fats." The body doesn't need very much of these good essential fats. It can obtain all that it needs from a diet which has 10% of calories from fat provided that the fat all comes from natural plant sources. In the natural plants all the fats are of the "cis" shape. There are two sources of the "trans" shaped fats. These are the refined oils, margarines, shortening, and the fat of ruminant animals. Bacteria in the stomach of animals such as the cow converts about 10% of their food fat into the Z-shaped trans fats.

Where we get into trouble is in the use of manufactured refined fat. In the refining of fat, four things are done to the oil by the factory. First, the oil is extracted from the seed by cold pressing the oil out. Some times a solvent is used to extract out more of the plant oil. Next, the free fatty acids are removed by vacuum and by the addition of lye. Thirdly, the oil is filtered through fuller's earth. Fourth, it is heated to 4750 F. It is then labeled "pure oil." How true that is! It is free of protein, starch, fiber, and most vitamins and minerals. It is in this last process and later in the formation of margarine or shortening that the shape of the fats is altered into the trans shape or when the double bond is moved along the fatty acid chain to a new position on the chain. Much of the factory refined fat and the animal fat is entirely different from what the body chemistry needs. The cell chemistry in the animals as well as processing by food factories may change the shape of the fats so that they interfere with the delicate chemistry balances in our bodies.13-15

Sizes and shapes are important. In the building of a stone house, the mason selects stones of a certain size and shape. Similarly, when a cell in the body is looking for fat, it is looking for one with a certain size and shape for a certain function. In the fat molecule, it is the number of double bonds and their location that determines their shape. If there are a lot of bizarre manufactured fats or trans fats in the way, the cells may settle for one that is not its first choice and use it for the job at hand.

Concentrated "Empty Calories" Cause Obesity:

Next, we come to another major problem that is related to a high fat diet. Fats furnish nine calories per gram of fat, over twice that supplied by protein, sugar, or starch. Foods that are high in fat content have a high satiety value, but they also make it easy to take in too many calories per meal. Foods that are low in fiber content and high in fat are "concentrated calories," a dietary situation that makes obesity a near certainty if they are eaten regularly over a long period of time.

The comparison below may help clarify how the free fats and certain foods can so easily increase the caloric intake of our diet.

One could get the equivalent of one tsp of oil (45 cal from fat) by eating only one of the following items:


2/3 oz beef steak 3 oz cooked soybeans
1 egg 7 almonds
1/2 cup whole milk 3 large black olives
1 tsp peanut butter  

By contrast, in order to get the equivalent of one tsp of oil a person would have to eat all of the following:

2 Irish potatoes 1 sweet potato
2 cups cooked lima beans 1 cup of green peas
1 head of lettuce 3 carrots
1 stalk of broccoli 1 cup of mushrooms
10 grapes 11 dates
1 apple  

Cells Need Proper Material For Cell Membranes:

What do the cells use fatty acids for? The body has several important uses for fats. The first one is for cell membranes. Every cell has a double lining of lecithins which are fatty acids chemically hooked up with a phosphorus complex. Inside of this double lining are a number of cell workshops which also have a double lining of lecithins. A very important workshop is the power generating plant called the mitochondria. Protein, glucose, and cholesterol also go into the making of the cell membranes.16

The important thing is this - if we eat too much of what we call saturated fats or too much of the bent-out-of-shape trans fats, then the cell walls will be too stiff. If we have excess cholesterol in the cell wall because of a high body cholesterol, that will make the wall stiff. Cells with stiff walls cannot work properly. They are subject to easy attack by viruses and germs. The person is more apt to get cancer and other problems.17 If the cells are not up to par, then we will not be up to par.

From studies that Dr. Aloia and I made on trans fats in tissue fat, these trans fats and bizarre fats gradually leave the cell membranes and body fat stores so that within a few months they have been exchanged for new ones.

Cells Need Proper Fats For Proper Chemical Formation:

The body uses fatty acids as the raw material for the formation of four sets of key chemicals in the body function. Let us consider just three of them. The body needs prostaglandins and thromboxanes. There are a number of these. They are made by certain cells. The cells look for a fat with a certain shape so that they can make a prostaglandin or thromboxane with a certain shape for a specific job. If the cells select a fatty acid that is shaped wrong, such as one in which the double bond is moved along the chain, then it makes a prostaglandin or thromboxane that is shaped wrong. Such a chemical cannot function as it was designed to function and the body cell that uses it will not work right. We know now that if the double bond is shifted a certain way the chemistry will go through the arachidonic acid pathway instead of the eicosapentanoic acid pathway.18-20

If the major chemical pathway is through arachidonic acid, the type of chemicals that are made will cause the arteries to constrict and the platelets to be sticky. This is probably one of the factors in raising blood pressure. If a patient wants to have more relaxed or dilated arteries, they should eat fats as they come naturally from the produce with the fats molecules in the right configuration.21

Proper Fats Needed For Immune System:

Also, in the body there are some cells in the immune defense system that are looking for fat of a certain shape to make antibodies of the right shape. There are regulator chemicals called "leukotrienes" that are manufactured from fatty acids by the T-lymphocyte and B-lymphocyte system so that antibodies can be made to destroy viruses. These are very important in the body's fight against cancer. Thus proper diet is very important in several ways in the battle against cancer. Meat, fish, fowl, milk, and eggs are a source of viruses for cancer. If we do not eat these, we avoid getting additional cancer viruses. At the same time we avoid the wrong kinds of fat and all that extra cholesterol in those foods, both of which makes the cell membranes less resistant to infections. If we eat natural unrefined produce, we get the right kind of chemicals to fight germs and viruses that cause cancer.22-24

The effect of a faulty diet on the immune system has also been implicated in the development of rheumatoid arthritis. Rheumatoid arthritis now appears to be caused by some kind of an infection.25 Some physicians think that the causative germ is an amoeba.26 Even though the infectious agent has not been settled on, it appears that the infection stimulates the body to make antibodies against the germ, whatever it may be. This antibody, made by action of the T- and B-lymphocyte cells grab hold of the germ. Other cells called polymorphs are then supposed to find these germ-antibody complexes, engulf them, and eat them up. If we have the wrong kind of fat in the diet, we will make the wrong kind of antibody, and the germ will not be destroyed.

A diet with a high content of refined sugar will result in the polymorphs being blinded so that they have difficulty finding the germ when it is held in the clutches of the antibodies.27 To make things worse, these wrong kinds of antibodies from the faulty fats, attack the joint tissues and cause inflammation, the swelling and pain of arthritis. Faulty prostaglandins made from wrong fats may also play a role in the distress of this kind of arthritis because they are very important in the manufacture of the lubricant for the joint. Complicated? Yes, but one more reason for changing the diet to natural produce. For further information, see the Addendum.

Fats Stimulate Cholesterol Synthesis in Our Body:

When we have a high fat diet, we turn on the formation of cholesterol by the liver and small intestines to digest and assimilate all that fat. That same diet usually is lacking in fiber and plant sterols which are of key importance in removing cholesterol out through the intestines. The result is a gradual accumulation of cholesterol in the body. A poem that I composed describes this situation:

    Cholesterol, once formed,
    Is not body degradable.
    It must be eliminated by the gut.
    Although that idea may be debatable,
    That is the problem simply put.

Fat and Oxygen Transportation:

A diet that is high in free or visible fats raises the blood fat level and causes the red blood cells to stick together in what is called "rouleaux formation." If the red cells are all stuck together as they go through the lung, they do not make good contact with the capillary wall in the right way to take on a load of oxygen. After they leave the lung and get down to the very small arteries, they are supposed to fold over and go through these smaller blood vessels one at a time. If they are stuck together at this point, it takes a little period of time for them to become released from each other and go through the arteriole one by one. Researchers have observed in the arteries of the eyeball that rouleaux formation can last for over twelve hours after a fatty meal. The net result is that the tissues do not get oxygen as readily as they should while this is present. We can now see why it is not unusual for patient with narrowing of the coronary arteries, to get anginal pain after a fatty meal.28

Balls Of Fat (Micelles) Damage Tissues:

Other authors have described a situation in which micelles, little balls of fat, get in high concentration in the tissues on a high fat diet. These can disrupt cell membranes, like a miniscule buzz saw. If this should occur in a critical cell like the conducting nerve bundle in the heart, it could cause a bundle branch block.29

High Fat Diet And Toxic Radicals:

The high fat diet can contribute to cancer of the skin, cancer of the colon, and diverticulosis of the colon in yet another way. When there is a high concentration of polyunsaturated triglycerides or cholesterol in the blood and skin they will be irradiated by sunlight and changed into toxic radicals. These toxic radicals damage the skin cells so that the viruses of skin cancer can attack the cells. A somewhat similar situation occurs in the large bowel. When a person is on a diet that is high in polyunsaturated fats, they have a higher content of bile salts and cholesterol in the feces. All of these have double bonds between carbon atoms in their chemical structure. These double bonds can be attacked by bacteria in the colon with the formation of poisonous toxic radicals. These toxic radicals can cause damage to the lining of the large bowel so that little diverticuli, out pouching, of the colon develop or cancer of the colon starts. Cancer of the skin, colon, breast, ovaries, pancreas, and prostate have all been attributed to a diet high in oil-type polyunsaturated fats or animal fats. All of this indicates that we should keep the fat level low in the diet.30-34 To make things worse these toxic radicals from fat and rancid cholesterol cause an increased risk of coronary heart disease.35

Recent evidence indicates that oxidized fats may become part of a “modified LDL" particle. In this form it is called lipoprotein(a).36 The “a" stands for an antigen protein that is formed in some way related to the oxidized fats. The body detects this as a foreign substance which needs to be removed from the system to guard the cells against oxidation in the wrong place such as in the cell membranes and genetic structure. Free circulating monocytes turn into macrophages (big eaters) and engulf these toxic radicals before they do further harm. Unfortunately, all this lipoprotein(a) in the macrophages results in the development of "foam cells" in the wall of the arteries and other damages.37,38

Thus two main mechanisms have been identified that will produces atherosclerosis. The first mechanism is the chronic excess of natural LDL. The second is the presence of the toxic modified LDL from oxygenation of monounsaturated, but mainly polyunsaturated fats that have been exposed to oxygen in such a way that they become oxidized.

Summary Of A Good Diet:

The food that we eat, then, should be chosen with great care. Our bodies and the chemicals that they make are dependent upon the food that we eat. Disease never comes without a cause.39 If the protein and/or fat comes already processed by some animal or by some food factory, we run the risk of getting something entirely different from what God intended for us to have for proper function.

In order to keep the cholesterol down, the diet should exclude all the refined foods and foods containing cholesterol. We can get all the nutrients that the body needs from fresh whole fruit, whole grains, legumes, green leafy vegetables, yellow vegetables, and nuts. The worse off we are in terms of health, the nearer we should aim at the center of the target of diet. In the outer circle of the target, everything is edible, flesh foods, milk, eggs, cheese, oil, margarine, sugar, white bread, fruits, nuts, and vegetables. To avoid disease, we should aim for the innermost circle of the dietary target. If we have coronary heart disease, diabetes, hypertension, obesity, and/or arthritis, and if we want to regain our health, our diet should consist of fruit, whole grains, vegetables, and greens. This diet along with fresh air, sunlight, pure water, rest, and exercise are true remedies.40 An old proverb says it by poetry. To these we would add two - temperance and trust in God.

    The best six doctors anywhere,
    And no one can deny it,
    Are sunshine, water, rest and air,
    And exercise and diet.
    These six doctors will gladly attend
    If only you are willing:
    Your ills they'll mend
    Your cares they'll tend
    And charge you not a shilling.

References

1. Morrison, LM: Diet in coronary atherosclerosis. JAMA 173:884-888, 1960.
2. Stamler, J: Lectures in preventive cardiology. Grune & Stratton, New York, 1967.
3. Diehl, H: In, HP Trowell and DP Burkitt, eds. Western Diseases: Their emergence and prevention. Edward Arnold Pub. Co., London, 1981, pp. 391-410.
4. Harper,NA, VW Rodwell, and PA Mayes: Review of physiological chemistry, 16th ed. Lange Medical Pub., Los Altos, CA., 1977, pp. 313-317.
5. Boyd, WA: A Textbook of Pathology, Lea & Febiger, Philadelphia, 1943, p. 395.
6. Thomas, WA, RA Florentin, SC Ham, et al: Preproliferative phase of atherosclerosis in swine fed cholesterol. Arch Pathol. 86:621-643, 1968.
7. Wissler, RW: Principles of the pathogenesis of atherosclerosis. In, E. Braunwald, Editor-in-Chief: Heart Diseases, Vol. 2, W. B. Saunders Co., 1980, pp. 1221-1245.
8. Vesselinovitch, D, SS Getz, RH Hughes, and RW Wissler: Atherosclerosis in rhesus monkeys fed three food fats. Atherosclerosis 20:303-321, 1974.
9. Adams, CWM. and YH Abdulla: The action of human high density lipoproteins on cholesterol crystals. Atherosclerosis 31:465-471, 1978.
10. Rauramaa, R, et al: Effect of exercise on serum lipoproteins and metabolites of arachidonic acid: A controlled randomized trial in middle aged men. Brit Med J. 288:603-604, 1984.
11. Haskell, WL, et al: The effect of cessation and resumption of moderate alcohol intake on serum high-density-lipoprotein subfractions. NEJMed. 310:805-810, 1984.
12. Sgantas, D and FA Kummerow: Incorporation of trans fatty acids into tissue lipids. Am J Clin Nutr. 23:1111-1119, 1975.
13. Anderson, RL, CS Fullmer, Jr., and EJ Hollenback: Effects of the trans isomers of linoleic acid on the metabolism of linoleic acid in rats. J of Nutr. 105:393-400, 1975.
14. Meyer, LH: Food Chemistry. Reinhold Pub. Co. New York, 1960, p. 49ff.
15. Heckers, H, M Horner, TL Tuschen, and FW Melcher: Occurrence of individual trans-isomeric fatty acids in human myocardium, jejunum, and aorta in relation to different defrees of atherosclerosis. Atherosclerosis 28:389, 1977.
16. Weissman, G and R Caliborne, editors. Cell Membranes; Biochemistry, Cell Biology, and Pathology. H. P. Publishing Co. Inc., New York City, N.Y., 1975.
17. Kinsella, JE, G Bruchner, J Mai, and J Shimp: Metabolism of trans fatty acids with emphasis on the effects of trans, trans octadecadienoate on lipid
composition, essential fatty acid, and prostaglandins; An overview. Am J Clin Nutr. 34:2307-18, 1981.
18. Bailey, JM: Trends in Biochemical Sciences 4:68, 1979.
19. Hwang, DH: Biosynthesis of prostaglandins dependent on availability of dietary linoleate. J Nutr. 105:995, 1975.
20. Marshall, LA, A Szczesniewski, and PV Johnston: Dietary Y-lenolenic acid and prostaglendin synthesis: A time course study, Am J Clin Nutr. 38:895-900, 1983.
21. Moncada, S and JR Vane: Arachidonic acid metabolites and the interactions between platelets and blood vessel walls. NEJMed, 300:1142-1147, 1979.
22. Merten, J: Essential fatty acids and cell-modulated immunity. Prog. Lipid Res. 20:851-856, 1981.
23. Curtiss, LK and TS Edgington: Differential sensitivity of lymphocyte subpopulation to suppression by LDL inhibitor, an immunoregulatory human serum low density lipoprotein. J Clin Invest 63:193-201, 1981.
24. Chisari FV, LK Curtiss, and FC Jensen: Physiologic Concentrations of normal human plasma lipoproteins inhibit the immortalization of peripheral B lymphocytes by the Epstein-Barr virus. J Clin Invest. 68:329-336, 1981.
25. Vauhan, JH: Rheumatoid arthritis: Evidence for a defect in T-cell function. Hospital Practice 19:101-107, 1984.
26. Wynburn-Mason, R: The causation of rheumatoid disease and many human cancers-A new concept in medicine. AC Publishing Co., Franklin, TN 37064, 1983.
27. Kijak, E, G Foust, and R Steiman: Calif. State Dental Assoc. 32:349, 1964.
28. Friedman, M, SO Byers, and RH Rosenman: Effect of unsaturated fats upon lipemia and conjunctival circulation. JAMA 193:882-86, 1965.
29. Katz, AM and FC Messineo: Lipids and membrane function: Implications in arrhythmias. Hospital Practice, July, 1981, pp. 49-59.
30. Hodgson, WJB: The role of fiber diet in uncomplicated diverticular disease. Internal Medicine 2:17-19, 1981.
31. Burkitt, DP, AR Walker, NS Painter: Effect of dietary fiber on stools and transit-times and its role in the causation of disease. Lancet 2:1408, 1972.
32. Wynder, E: The dietary environment and cancer. JADA. 71:385-392, 1977.
33. Harman, D: Prolongation of life: Role of free radical reactions in aging. J Am Geriatr. Soc. 17:721-735, 1969.
34. Black, HS, JT Chan, and GE Brown: Effects of dietary constituents on ultraviolet light-mediated carcinogenesis. Cancer Res. 38:1384, 1978.
35. Kummerow, FA: Nutrition imbalance and angiotoxins as dietary risk factors in coronary heart disease. Amer. J. Clin. Nutr. 32:58-83, 1979.
36. Witztum JL and D Steinberg: Role of oxidized low density lipoprotein in atherogenesis. J Clin. Invest. 88:1785-1792, 1991.
37. Heinecke JW: Free radical moldification of low-density lipoprotein: Mechanisms and biological consequences. Free Radical Bio & Med 3:65-73, 1987.
38. Esterbauer, H: Cytotoxicity and genototoxicity of lipid-oxidation products. Am J Clin Nutr 57 (suppl): 779S-86S.
39. White, EG: Ministry of Healing, Pacific Press Pub. Assoc., Mountain View, CA, 1905 and 1942, p. 234.
40. ibid. p. 127.

Addendum to "Role of Cholesterol and Excess Fat in Disease"

Omega-3 and Omega-6 Fat in Plant Produce: Data from an article in the Journal of the American Dietetic Assoc.1 on omega-3 (w3) and omega-6 (w6) content of foods revealed information as shown in the table below. We note that as one goes progressively from green or sprouted soy beans to dried soy bean, to soy oil, to partially hydrogenated soy oil, to soybean hard margarine, there is a progressive loss in the relative amount of omega-3 oils.

Percent of Total Polyunsaturated (PUFA) as Omega-3 and Omega-6 and Percent of Total Fats as Omega-3 and Omega-6 in Selected Foods
 
% of Total PUFA
% of Total Fats
  as Omega-6 as Omega-3 as Sat as Mono as Omega-6 as Omega-3

Green or Dry-Sprouted Soybean 16 84 11 11 9 47
Common Dry Beans 33 67 13 7 20 40
Lettuce (Butterhead) 50 50 tr tr tr 50
Broccoli 50 50 tr tr 25 25
Kale 33 67 tr tr 14 29
Raspberries 50 50 9 23 33 16
Green Peas 50 50 16 4 8 8
Walnuts 79 21 9 23 53 11
Avocado 94 5 15 65 11 1
Wheat 92 8 16 12 44 4
Wheat Bran 92 8 15 15 48 4
Wheat Germ 89 11 17 15 54 6
Oat Germ 89 11 17 36 36 5
Corn Germ 98 2 13 25 58 2
Barley Bran 89 11 19 11 45 6
Rice Bran 97 3 19 38 33 1
Dry Soybean 87 13 15 21 50 8
Soybean Oil 88 12 14 23 51 7
Soybean Oil Partially Hydro. 93 7 15 43 35 3
Soybean Hard Margarine 93 7 21 48 24 2
Soybean Shortening 25 2 25 45 25 2
Butter or Cream 62 38 62 29 1 2
Pork 88 12 37 46 10 1
Lard 91 9 48 40 7 1
Beef Fat 62 38 46 44 2 1
Fowl Values 96 4 28 41 21 1
Values calculated from data of FN Hepburn, et al.1

There are some who would contend that "free" oil is safe to use whereas animal fats and vegetable greases are the main health hazards from fat. They would allow the use of free fats, cause imbalances in nutrients, which would hamper optimal health, and wait until it has been proven by science or until a disease happens before reorienting their diet to one as near God's original diet as possible. But the omega-3 a-linolenic acid is an essential oil.2 By the simple maneuver of eating natural produce, we can obtain the balance that God prepared in the fruits, vegetables, nuts, and grains.

Some are trying to balance the omega-6 arachidonic acid fats from meat, milk, and eggs by increasing the intake of the omega-3 eicosapentanoic acid fats from fish. It may be difficult to prove it, but we believe that a better way would be to supply plant produce in proper fashion with adequate omega-3 a-linolenic acid as found in the plant cells and let the body select its needs from the natural produce. Perhaps the importance of using the natural produce as a source of fats [and other nutrients] can be seen from the diagram below:

Linoleic acid

Some of the chemistry of the above was presented in a review article, and we realize these topics are under active study.3 Each year brings more insight. The relative availability of these fats influence the production of the leukotrienes because they go into the cell membranes where this chemical process is performed.3 In that review article is presented evidence of what happens in a little of the chemistry of cell membranes of mast cells, peripheral lymphocytes, and splenocytes. These changes modulate and modify the production of prostaglandins, and leukotrienes which are the communicators of the T-lymphocytes, B-lymphocytes, and granulocytes among other members of the immune system. "There is considerable evidence that eicosanoids have a modulatory role in immunity, but precisely which cell produces PG and related products is still a matter of controversy.... Lipoxygenase products including LTB4 and leukotriene D4 show some inhibitory effect on human lymphocytes proliferative response to Con A."

There is much to learn, but available evidence points to cell membrane chemistry as of great importance in the immune system. Just how, remains to be worked out, but we know how to get the best source of fatty acids. If we go second hand to the animals, we get an arachidonic acid type of fat in predominance. If we go to the fish, we get an eicosapentanoic type of fat in predominance. If we go to processed oils, the products from omega-6 fats will predominate. If we go to the plants, the body can select a pathway that goes through either of those 20-carbon fats, or else go through pathways entirely different, starting from the 18C:2 w6 or 18C:3 w3 source chemicals. Who among us can say that that is not important? In one study "a 1% absolute increase in a-linolenic acid (adipose stores) was associated with a decrease of 5 mm Hg in systolic blood pressure."4 A vegetarian diet has been shown to dramatically change platelet fatty acids and platelet function.5 Some persons may not care to believe this, but it is more than just the amount of fats in the diet. The dietary fat source is important because that defines which type of fats will get into the body and hence into the cell membranes. I would direct the reader to the use of plant produce as grown and away from the use of refined free fats, or animal fats, or fish fats.

Information From The Writings of Ellen White on Free Fats

Ellen White wrote: "Fruits, grains, and vegetables, prepared in a simple way, free from spice and grease of all kinds, make, with milk or cream, the most healthful diet. CDF92 (1890).

"A plain diet, free from spices, and flesh meats, and grease of all kinds, would prove a blessing to you..." CDF83 (1868).

"You should keep grease out of your food. It defiles any preparation of food you may make." CDF200 (1868).

"You should keep grease out of your food." CDF256 (1868).

"Grains and fruits prepared free from grease, and in as natural a condition as possible, should be the food for our tables of all who claim to be preparing for translation to heaven." CDF64, (1869).

"The grease cooked in the food renders it difficult of digestion." CDF236 (1890).

There are some who wish to make an issue over whether Ellen White meant to include oil as a grease. Webster's dictionary fails to distinguish between oil and grease. Grease = "rendered animal fat" or "oily matter." Oil = "Any of various kinds of greasy combustible substances obtained from animal, vegetable, and mineral matter." Grease is oily, and oil is greasy. Oil is some kind of grease, and we are admonished not to use “grease of any kind."

Chemically speaking, the distinction between a "grease" and an "oil" is of academic importance but not of dietary importance since the oily grease can be turned into a greasy oil by warming. Whether a fatty acid compound is more of a gel or a liquid depends upon the length of the fatty acid chains and the number of unsaturated double bonds. Long chain fatty saturated fats (18 carbons or so), which would be unctuous at room temperature, are dissolved in the mixture of polyunsaturated and short chain fats. It might take, gram for gram, more emulsifiers to prepare a long chain saturated "hard fat" for digestion than it would a long, chain polyunsaturated liquid oil, but this has not been determined.

Basically, the intestinal tract works in a water phase and not in an oil medium. All the oily characteristics of free fats, liquid or unctuous, need to be dealt with before the hydrolysis of anything, fats, carbohydrates, or fats, can proceed properly.

John Harvey Kellogg was director of Battle Creek Sanitarium, an early Seventy-day Adventist health-conditioning center. Apparently he understood the above statements by Ellen White to mean any type of free fat. "The objection is not against fat, per se, but against taking it in a free state. When taken in the form in which nature presents them, enclosed in cells in such vegetable foods as maize, oatmeal, nuts, and some fruits, fats are wholesome and nutritious elements of food. It is only when separated from the other elements and taken in a free state that they become unwholesome. When taken into the stomach in the form in which nature furnishes them, they offer no obstacle to digestion. It is only when taken as free fats that they become a means of producing disturbance of digestive functions. When taken in their natural state, vegetable fats are likely to be taken only in such quantity as can be digested... It makes little or no difference, so far as the interference with digestion is concerned, whether the fat is animal or vegetable... the persistent efforts of individuals to discover some cheap vegetable substitute for butter and lard are painfully ludricrous… We do not recommend the use of any free fat."6

D. E. Robinson, presents a menu and some comments about a dinner at a ceremony for rededication of the Battle Creek Sanitarium by a friendly editor of the local Battle Creek Journal on July 21, 1871. The menu is as follows:

Vegetables: New ripe potatoes, green beans, green corn, beets, squash, green peas, baked beans.

Bread, Cake, Etc.: Gems, raised bread, hard biscuits, buns, fruit cake (graham), sponge cake (graham), oatmeal pudding, manioca pudding with fruit, rice pudding with fruit.

Fruit: Peaches, prunes (dried), dates (dried), apples, whortleberries, blackberries." The editor further comments, "It is to be noticed that butter, grease of all kinds, tea, coffee, spice, pepper, ginger, and nutmeg, were wholly discarded in the cookery, and were not in use upon the tables."

References for Addendum

1. Hepburn FN, J Exler, JL Weihrauch: Provisional tables on the content of omega-3 fatty acids and other fat compounds of selected foods, JADA 86:788-793, 1987.
2. Holman, RJ and SB Johnson: Essential fatty acid deficiencies in man. In Dietary Fats and Health, eds. EG Perkins and WJ Visek, Am Oil Chemists' Society, Champaign, Illinois, 1983, pp. 247-266.
3. Johnston, PV: Dietary fat, eicosanoids, and immunity, in Advances in Lipid Research, Vol 21, ed. R Paoletti and D Kritchevsky, Academic Press, Orlando, 1985, pp 103-141.
4. Berry, EM and J Hirsch: Does dietary lenolenic acid influence blood pressure?, Am J Clin. Nutr. 44:336-340, 1986.
5. Fisher, M, PH Levine, B Weiner, et al: The effect of vegetarian diets on plasma lipids and platelets levels. Arch Int. Med 146:1193, 1986.
6. Kellogg, JH, Health Reformer, May, 1877, page 146.
7. Robinson, DE: The Story of Our Health Message, Southern Pub. Assoc., 1943, p.161.

Copyright © 1995-2002 Milton G. Crane, M.D. and Barbara G. Crane, R.D., Weimar Institute, Weimar, CA 95736. All rights Reserved.