Heart Attack Rareness in Thyroid-Treated Patients.

Book Reviews
Heart Attack Rareness in Thyroid-Treated Patients.
By Broda O. Barnes, Charlotte W. Barnes. . 95 pages. Charles C Thomas, Publisher, Springfield, Illinois, 1972. Price, $7.25.
Excerpt
Current approaches to the prevention of heart disease are directed toward the importance of such causative factors as improper diet, cholesterol, exercise, and smoking. The authors of this monograph disagree. They suggest that thyroid hormone deficiency is the cause of atherosclerosis and possibly of other illnesses. They present their reasons for believing that hypothyroidism is not diagnosed nor treated as frequently as it exists and should be watched for and treated at earlier ages.

The authors indicate their dissatisfaction with the usual tests of thyroid function; they prefer to use axillary temperatures to bolster clinical impressions of thyroid function

http://www.annals.org/content/78/3/474.1.extract

Book Reviews
Heart Attack Rareness In Thyroid-Treated Patients by Broda O. Barnes, Ph.D, M.D. and Charlotte W. Barnes, M.A., Charles C. Thomas Publisher, 1972.

In this short treatise, the authors try to explain the meteoric rise of heart attacks, a disease that was very rare at the beginning of the twentieth century, but became the major cause of death by the 1950s. They cite changes in the environment usually given as explanations such as increased sugar consumption, the reduction of physical effort in routine work due to modern machinery in industrialized nations, the consumption of coffee, soft drinks, artificial sweeteners, pollution from industry and the automobile, cigarette smoking, stress of modern life and of course saturated fat and cholesterol. They go into some detail in debunking saturated fat and cholesterol as possible causes.

“Blaming saturated fats in the diet seems unjustified, since in reality these constituents for many people today are no higher than they were in the diet of our ancestors two hundred years ago. At that time most of the population lived on farms where fresh dairy products and eggs could be produced economically at any season of the year. During the winter months meat could be preserved; fat meat was more palatable than tough lean meat. During the summer months cured bacon and hams were supplemented with pork sausage fried down in lard.

Butter was used in abundance on the hot biscuits and on bread, which made up no small part of the diet. The milk was cooled for several hours in the old spring house where a slow stream of water acted as a refrigerator. Thick cream was skimmed off the milk and was used generously on fresh or canned fruit.

If a high cholesterol diet was as dangerous as alleged, all of the farmers would have died of heart attacks centuries ago, and the rest of the world would have starved to death. Will Rogers said that there was no substitute for horse sense; this has surly been neglected in our reasoning about heart attacks.

The farmers were not dying from heart attacks one hundred years ago, nor were the doctors missing the diagnoses. As late as 1930 autopsy studies at Graz, Austria (to be discussed later), showed only one heart attack per 125 deaths. The diet of the Austrian has been similar to that in the United States. The farms are small and have cows, pigs, chickens, and beef animals. Dairy products are relatively cheap and consumed in large quantities. In 1970 the autopsies at Graz showed one heart attack for each 14 deaths, a rise of over 800 percent in thirty-five years. Later it will be shown that diet was not to blame for this rise.”

The authors contend that the most likely factor for the rise of heart attacks is not a change in environment but a change in the human population itself. Two hundred years ago over half the people born died before reaching adulthood. Infectious diseases such as epidemic diarrhea, smallpox, and tuberculosis were responsible for premature deaths. Today such infectious diseases are rare. In the past only people who were resistant to infectious diseases attained old age. Those who were susceptible succumbed as children and young adults. The authors attribute the decline of infectious diseases to the success of modern medicine ie. vaccinations and antibiotics. (Others might attribute the decline to better public sanitation, housing, and clean water.) As the result of this success senior citizens consist of two groups. The first one is composed of individuals resistant to infectious diseases. Those who have survived infectious diseases have usually succumbed to cancer, hypertension with eventual heart failure, diabetes, strokes etc. The second one is composed of individuals susceptible to infectious diseases but have reached old age due to immunizations and antibiotics. This group constitutes a “new population” that never existed before the twentieth century. Just as they differed in their susceptibility to infectious diseases, it wouldn’t be surprising if they differed in their susceptibility to degenerative diseases.

“The changes in the death patterns can be readily explained if one assumes that “the new population” contains a preponderance of individuals susceptible to three diseases, namely, emphysema, lung cancer, and heart attacks. It has been demonstrated that patients with tuberculosis are twenty times more susceptible to lung cancer than are members of the general population (1). For years both tuberculosis and lung cancer were frequently found in the same patient,clearly showing that both diseases were competing for the life of the same individual. Emphysema has always been associated with infectious diseases.

Heart attacks were first associated with infectious diseases during World War II (2). There were 866 myocardial infarctions in men below the age of 40 among the 15,000,000 American military personnel. Only two important correlations were found: a family history of the disease in those afflicted, and a history of a previous pneumonia in the patient himself. Pneumonia is an indication of a low resistance to infectious diseases. Those individuals susceptible to infections are also more prone to heart attacks.

Thus it appears that “the new population” is more susceptible to a few diseases; this observation is a major factor in the radical change in death patterns in the twentieth century. Such a thesis is supported by the facts that no country with a high incidence of infectious diseases has had significant numbers of heart attacks, emphysema, and lung cancer. Conversely, no country has failed to see a rapid rise of these three afflictions as infectious diseases have been curtailed.” Observations that lent plausibility to the lipid hypothesis

1. In 1913 Anitschkow, a Russian scientist, discovered that after having fed rabbits huge doses of cholesterol, atherosclerosis occurred in their arteries. These atherosclerotic lesions contained cholesterol. A cause and effect relationship seemed apparent.

2. In 1916 Delangen, a Dutch doctor in Java, noticed that serum cholesterol levels were lower in the native population than among the Dutch. When the Javenese worked on Dutch boats and ate the Dutch food, their cholesterol levels rose approaching those of the Dutch. In Holland the population consumed considerably more cholesterol from food than the population in Java. Atherosclerosis appeared more often in Holland. Consumption of cholesterol seemed responsible for these differences.

3. During World War II, European consumption of animal foods was greatly reduced causing cholesterol intake to decline sharply. There was also a steep decline in the number of heart attacks and other diseases with atherosclerosis. After the war. when the Europeans resumed eating their pre-war diet, the incidence of heart attacks started rising again.

4. During the Korean conflict Enos reported 300 autopsies on American soldiers killed in combat. In 77 percent of these autopsies there was found atherosclerosis. Enos suspected considerable narrowing of the lumen, although no measurements were made. None of the American soldiers had a record of any heart symptoms. Their age ranged from 18 to 48 years. In 200 cases the average was 22.1 years. Autopsies on Koreans did not show the same degree of atherosclerosis.

Observations that undermined the plausibility of the lipid hypothesis

1. Cholesterol-feeding does not cause a marked rise in serum cholesterol nor the development of atherosclerosis in rats, dogs, or man. A rabbit is a herbivore. It doesn’t consume cholesterol. In Anitschkow’s experiment a two-pound rabbit was forced to ingest as much cholesterol as a 150-pound man normally consumes.

2. Not all strains of rabbits reacted to cholesterol-feeding like those in Anitschkow’s experiments. Turner in 1938 found that when those susceptible to cholesterol-feeding were given thyroid in therapeutic doses, serum cholesterols were lowered and the development of atherosclerosis was prevented. When animals resistant to cholesterol-feeding had their thyroids removed their serum cholesterol level rose and atherosclerosis occurred. Thyroid deficiency seemed more important than excess cholesterol to explain atherosclerosis in rabbits.

3. Malysheva in 1964 found that before cholesterol-fed rabbits developed atherosclerosis their metabolism fell to the level seen in rabbits whose thyroid gland had been removed.

4. The authors spent their summers in Graz Austria located in a goiter belt due to the iodine deficiency of the soil. About 75 percent of the total deaths in the city are autopsied each year. Over 2,000 post-mortem occur annually. 70,000 consecutive autopsie reports covering the years 1930-1970 were personally reviewed.

1954-1958

At 30 years of age 9 percent showed visible atherosclerosis. By age 60 atherosclerosis was present in 72 percent of the cases. Above age 60 it was rare to find an individual without atherosclerosis. The population of Graz suffered from hypothyroidism. Iodized salt still hadn’t been introduced. People with goiters were seen walking the streets and on the autopsy table. These observations lent support that hypothyroidism enhances atherosclerosis. Although there was more atherosclerosis seen than in the United States, the death rate from heart attacks was only one-tenth of that in America.

World War II (1939-1945)

In 1939 12 heart attacks per 1,000 autopsies. In 1945 there only three per 1,000 autopsies, a decline of 75% similar to the experience of other European countries. It had been assumed by supporters of the lipid hypothesis that the low cholesterol diet during the war had arrested the development of atherosclerosis. However at the height of the war the number of autopsies showing atherosclerosis in those below the age of 50 was nearly double the number before the war. The degree of arterial damage was also doubled. Atherosclerosis had increased.

“This was a paradox and cast serious doubt on the cholesterol theory. The answer was very simple. If patients were not dying with heart attacks, what other diseases were claiming their lives? Consequently, a review of all causes of deaths among individuals between the ages of 30 and 60 were tabulated. The most outstanding change was an explosion of tuberculosis. Other infectious deaths also rose but tuberculosis will illustrate the point. In 1939, tuberculosis was responsible for 27 deaths per 1,000 autopsies among men in this age group. In 1944, the same disease had killed 55 similar-aged males. Deaths from tuberculosis occur at a much younger age than do those from heart attacks.

Tuberculosis alone had eliminated 28 potential candidates for heart attacks before their arteries were fatally occluded. A rise in other infectious deaths had removed many more. The drop in heart attacks had been only 8 per 1,000 autopsies. There was no paradox. During the war, less cholesterol was ingested, but other factors had caused a marked increase in atherosclerosis. Tuberculosis and other infections were killing those with accelerating atherosclerosis before heart attacks could occur. The drop in the latter during the war was not due to less cholesterol in the diet, but was due to a deterioration in health with a consequent rise in infectious diseases.

These observations showed very clearly why Graz had never had a high incidence of heart attacks. Infectious diseases had always been more prevalent in this location than in other modernized areas. This was not due to inferior health regulations but was related to one of Mother Nature’s variations. The lack of iodine in the soil and water had rendered the inhabitants deficient in thyroid hormones for centuries.

The other countries in Europe seeing a drop in heart attacks during the war had a rise in deaths from tuberculosis comparable to that in Graz. There was no rise in tuberculosis in the United States; There was no decrease in heart attacks. England has a smaller rise in tuberculosis and a correspondingly smaller drop than was experienced by the occupied countries. Germany had a tremendous increase in tuberculosis and a reciprocal fall in the number of heart attacks. There seems little doubt that the drop in heart attacks during World War II was due to the elimination of potential candidates prematurely by tuberculosis and other infectious diseases.”

“…At Graz the high incidence of deaths from tuberculosis and other infectious diseases continued unabated until the end of World War II. It was the use of antibiotics that finally reduced the carnage from infections in that city. In 1945 only 3 heart attacks per 1,000 autopsies were recorded, but the following year they started to rise and have been accelerating ever since. In 1946 the diet was low in cholesterol, there was little smoking since cigarettes had not been available to the civilians during the war, there should have been less stress since the war was over and there was hope for the future, the automobile had not arrived, and everyone had plenty of exercise. ”

5. Diets low in cholesterol do not prevent atherosclerosis.

Strong in 1969 reported the results of over 4,000 autopsies on babies, children, and young adults from five impoverished areas. These included the Charity Hospital in New Orleans and hospitals in Santiago, Costa Rico, Guatemala, and Durban, South Africa where the Bantu were examined. Despite minimal cholesterol consumption beginning atherosclerosis was detected in many children under age 3 and in all of those over three. Atherosclerosis was found more in the aorta than the coronary arteries. but by age 30, 90 percent of the cases showed atherosclerosis in the coronary arteries.

“These clear cut results distinctly show that diets low in cholesterol do not prevent early atherosclerosis. In fact quite the converse is true; autopsies on better-fed Americans or on those of any nationality eating a similar high cholesterol diet show far less atherosclerosis in children and young adults. In the under-privileged countries, obviously something happens between childhood and middle age that prevents early atherosclerosis from progressing to heart attacks.”

“…It is now possible to construct a rational explanation for most of the facts relative to diet and heart attacks. It is true that the countries ingesting little cholesterol have a low incidence of heart disease. However, they have a high incidence of infectious diseases including tuberculosis which eliminates young adults. In the modernized countries a high level of cholesterol is eaten, but with progress comes better medical care and fewer infectious diseases….it was pointed out that Graz had a high cholesterol intake, but infectious diseases kept the rate of heart attacks low until the antibiotics reduced the latter. A rapid rise began at that time and is accelerating.”

6. Atherosclerosis is greater during war than before or after it.

“World War II was accompanied by a marked drop in heart attacks in Europe. Without looking at the autopsies, Keys (9), one of the leading proponents of the cholesterol theory, stated that no rational explanation other than a change of diet was evident. Autopsy studies now reveal more atherosclerosis during the war than before or afterwards. Although these preliminary reports of Barnes and Ratzenhofer have been published, the enthusiasts have ignored them. Finally the premature atherosclerosis in the American soldiers killed in Korea was found to be no greater than in soldiers in previous wars in which there were no high cholesterol diets. Thus none of the circumstantial evidence can be used to support the cholesterol theory. In fact, there is no convincing evidence that cholesterol is concerned with heart attacks.”

Observations that support the hypothesis that hypothyroidism causes heart attacks.

1. In 1878, Ord did an autopsy on a patient who died from failure of the thyroid gland. One of the findings was severe atherosclerosis in the lumen of all arteries.

2. The London Clinical Society had requested Dr. Victor Horsley to produce the same results in experimental animals. The results were published in 1881. “Within seven days after removal of the thyroid gland in monkeys, the connective tissues in the blood vessels developed deposits of mucin-yielding compounds compounds which led to mucoid degeneration followed by fibrous tissue. It will be seen presently that this same process is the initial lesion in arteries leading to atherosclerosis in all species.”

3. In 1883 Kocher, a Swiss surgeon, removed goiters which were suffocating patients. One-third of patients who underwent a complete thyroidectomy developed systems described by Ord. Billroth a prominent Viennese surgeon confirmed Kocher’s observations.

4. Von Eiselsberg reported in 1895 that thyroidectomy in sheep or goats caused atherosclerosis in the arteries, including the coronary arteries. Pick and Pineless confirmed these results a few years later. They also found that thyroid therapy would prevent premature damage to the arteries.

5. In 1927 Friedland, a coworker of Aniitschkow, suggested using thyroid therapy to prevent atherosclerosis.

6. In 1951, Dr. William B. Kountz published the results of observations of 288 patients. The patients were divided into 3 groups. The first group were composed of patients in Kountz private practice with an average age of 55. They had very little evidence of atherosclerosis. The second group consisted of outpatients from the infirmary at Washington University in St. Louis. Their average age was 61 years and many of them had moderate degrees of cardiovascular damage. The third group consisted of inpatients at the infirmary. Their average age was 67 years and each patient had advanced disease of the blood vessels. All 288 patients had a low basic metabolic rate and many had high levels of serum cholesterol. In each group some patients were given thyroid therapy while other were kept as controls. Over five years death results from heart attacks or strokes were tabulated. In the first group none of those on thyroid therapy died, while 15 percent of the controls died from fatal vascular events. In the second group 3 percent on thyroid therapy died as opposed to 19 percent of the controls. In the third group, where death was expected at any time, those on thyroid therapy had a death rate 50 percent less than that of the controls. It was Kountz’s work that influenced Broda Barnes to investigate the incidence of heart attacks among his thyroid-treated patients.

7. By 1950 Broda Barnes had developed a large practice over thirteen years with a sizable percentage of patients whose complaints had been resolved by thyroid therapy. When a friend of his had a heart attack, Barnes found that he had suffered for several years from untreated symptoms of hypothyroidism. While at the same time his treated patients had not suffered any heart attacks during a decade when the incidence of heart attacks was rising rapidly in the United States. Barnes had always screened his patients for hypothyroidism. Any patient who had an axillary temperature below 97.8 degrees upon awakening after a good night’s sleep and had symptoms that hadn’t responded to other medications was given a therapeutic trial on thyroid therapy. Dosage could be increased as long as the axillary temperature didn’t exceed 98.2 degrees Fahrenheit. In 1950 he started to investigate the role of hypothyroidism in heart disease.

Starting in 1950 in addition to screening patients for hypothyroidism, each patient was questioned about a history of familial heart disease. Each received a chest x-ray for heart size, a cardiogram, and appropriate blood work. The only dietary change ever made was the addition of more saturated fats, including eggs and dairy products. Barnes himself usually ate a breakfast of bacon and eggs. There was no recommendation to increase exercise or to stop smoking. Any patient having symptoms of thyroid deficiency, including subnormal temperature, received a dessicated porcine thyroid tablet.

After 20 years the results of heart attack incidence in his private practice were compared to the results of occurrence in the Framingham study. The Framingham study had emphasized the following risk factors in heart attacks. Incidence is higher in males. The risk is increased in those with a family history of the disease. High serum cholesterol and/or hypertension are predisposing. Frequency increases with age. Barnes grouped his patients into categories used by the Framingham study.

Sex Condition #Treated PatientYears ExpectedCases**Actual Cases

F Age 30-59 490 2705 7.6 0

F High-Risk* 172 1086 7.3 0

F Age over 60 182 955 7.8 0

M Age 30-59 382 2192 12.8 1

M High-Risk* 186 1070 18.5 2
M Age over 60 157 816 18.0 1

Totals 1569 8824 72.0 4

*Hypertension and/or Hypercholesterolemia

**Compared with the Framingham Study

A total of 1560 patients were in the study. Some had been on thyroid therapy thirty years. The minimum time to qualify for comparison with the Framingham group was two years. The results show that both sexes benefited from thyroid treatment. High-risk and older patients had relative immunity. Only four heart attacks occurred instead of the expected 72. This constitutes a reduction of 94 percent.

Barnes had former patients who stopped thyroid therapy. Some relocated to different areas and their new physicians refused to continue treatment. Other physicians stopped thyroid supplementation because one of the thyroid function tests was normal. Some patients stopped taking their thyroid medication when symptoms of thyroid deficiency went away.

“At least 30 fatal heart attacks were known to have occurred prematurely among those who discontinued therapy. A high percentage of young individuals in this group indicates an increased susceptibility to hardening of the arteries. Two were under the age of 30, one between 30 and 40, two between 40 and 50, and eight between 50 and 60. These were all premature heart attacks; in each instance, the individual had been diagnosed thyroid deficient several years earlier at which time there were no evidence of heart disease. Thus, 13 out of 30 dropouts had heart attacks before the age of 60; this incidence is approximately double that seen in the population as a whole. It would appear that the hypothyroid patient is more susceptible than others to the ravages of premature heart disease.”

Instead of trusting your heart to a statin, you might consider the alternative of a dessicated porcine thyroid tablet if your axillary body temperature is less than 97.8 degrees upon awakening after a good night’s sleep.

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