Dad you may have been misguided about cholesterol

Gov­ern­ment Admits Mis­guided War on Cholesterol

For the last 4 decades, North Amer­i­cans have been warned that foods high in fat and cho­les­terol lead to heart dis­ease, obe­sity and other ill­nesses. Adults have been encour­aged to reduce their fat intake to about 30 per­cent of their total daily calo­ries. And cho­les­terol low­er­ing drugs (statins) have been pop­u­larly prescribed.

Just ear­lier this year, in Feb­ru­ary 2015, the new 2015 Dietary Guide­lines for Amer­i­cans were released. The Dietary Guide­lines Advi­sory Com­mit­tee no longer clas­si­fies cho­les­terol as a “nutri­ent of concern.”

Cho­les­terol is essen­tial for our health. It is found not only in our blood­stream, but also in every cell in the body, where it helps to pro­duce Vit­a­min D, hor­mones, cell mem­branes and bile acids that help you digest fat. It’s also a pow­er­ful antiox­i­dant and assists in repair­ing injuries, and is vital for neu­ro­log­i­cal function.

Read Dr BJ Hardick’s blog below to learn more.

Are Cho­les­terol Guide­lines “Misguided”?

When the Wash­ing­ton Post deliv­ered the mes­sage that “The U.S. gov­ern­ment is poised to with­draw long­stand­ing warn­ings about cho­les­terol” on Feb­ru­ary 102015, Amer­i­cans prob­a­bly weren’t antic­i­pat­ing the true ram­i­fi­ca­tions of what these amend­ments would really mean. Released just days later, the new 2015 Dietary Guide­lines is a stark reminder that we sim­ply can­not trust the U.S. gov­ern­ment for dietary advice and that they have know­ingly with­held infor­ma­tion from us for lit­er­ally decades. (1)

Buried as a pass­ing com­ment on page 90 of the 571-page Sci­en­tific Report of the 2015 Dietary Guide­lines Advi­sory Com­mit­tee, we are now told to dis­miss decades worth of warn­ings against super foods like raw milk but­ter and cheese and advice to con­sume highly toxic hydro­genated oils.

Pre­vi­ously, the Dietary Guide­lines for Amer­i­cans rec­om­mended that cho­les­terol intake be lim­ited to no more than 300 mg/day. The 2015 DGAC will not bring for­ward this rec­om­men­da­tion because avail­able evi­dence shows no appre­cia­ble rela­tion­ship between con­sump­tion of dietary cho­les­terol and serum (blood) cho­les­terol, con­sis­tent with the AHA/ACC (Amer­i­can Heart Asso­ci­a­tion /Amer­i­can Col­lege of Car­di­ol­ogy) report. Cho­les­terol is not a nutri­ent of con­cern for over­con­sump­tion.” (2)

No kid­ding!

In a nut­shell, the “new” guide­lines tell us some­thing we’ve observed in nat­ural health for decades:

The amount of cho­les­terol you con­sume has noth­ing to do with your body’s level of cho­les­terol!
We’ve known this since Uffe Ravn­skov, MD, PhD blew opened Pandora’s box when he pub­lished his book Koles­terolmyten (“The Cho­les­terol Myths”) in Swe­den in 1991 and in Fin­land in 1992.

The World Mis­lead
To be fair, we can­not place all the blame on the U.S. gov­ern­ment. The “cho­les­terol is harm­ful” hypoth­e­sis has been around for quite a while. (3)

2650 B.C. Huang Ti – the Yel­low Emperor of China recorded a “hard­ened pulse” and sug­gested that it was asso­ci­ated with a high salt intake.
400 B.C. – Hip­pocrates sug­gested that ill­ness resulted from imbal­ance of four bod­ily humours: yel­low bile, black bile, blood, and phlegm.
1500 AD – Leonardo da Vinci first described ath­er­o­scle­ro­sis via the term “tunics.“
1772 – Eng­lish physi­cian, William Heber­den, reported that the blood serum of an obese patient who expe­ri­enced a sud­den death was thick like “cream.“
1799 – Coro­nary artery hard­en­ing was first described by Eng­lish physi­cian, Caleb Hiller who found a gritty sub­stance in coro­nary arter­ies while doing an autopsy.
1815 – Lon­don sur­geon, Joseph Hodg­son, advanced a novel the­ory of ath­er­o­scle­ro­sis. Hodg­son sug­gested that inflam­ma­tion was the under­ly­ing cause of the dis­ease rather that a nat­ural part of the aging process. In that same year, how­ever, cho­les­terol was dis­cov­ered by a French researcher and Hodgson’s the­ory was largely ignored.
1841 – Carl Von Roki­tansk, one of the first pathol­o­gists, pro­posed that the deposits he observed in the inner layer of arter­ies were derived from sub­stances cir­cu­lat­ing in the blood. The pri­mary com­po­nent of arte­r­ial plaque was shown to be cho­les­terol just two years later.
1949 – “Cho­les­terol is Harm­ful” hypoth­e­sis advanced by J. W. Gof­man, an Amer­i­can physi­cian who was research­ing fats in the blood­stream and pro­posed LDL caused plaque.
The hypoth­e­sis gained addi­tional sup­port when autop­sies of young sol­diers killed in the Korean War revealed that 77.3 % had cho­les­terol deposits in their coro­nary arter­ies.
The under­ly­ing argu­ment has been that cho­les­terol is the main insti­ga­tor in arte­r­ial occlu­sion much like sep­tic sludge clog­ging up a drain pipe. Although, “The vas­cu­lar tree,” accord­ing to car­di­ol­o­gist Michael Ozner, “Is an active, liv­ing organ that expands and con­tracts in response to dif­fer­ent stim­uli, not a net­work of rigid metal con­duits. Its walls are per­me­able – and cho­les­terol does not just build up inside an open space like so much drain­pipe sludge.” (4)

And accord­ing to the Williams Text­book of Endocrinol­ogy, 11th ed, “Ini­tially, it was thought that the [arte­r­ial] lumen was pro­gres­sively nar­rowed by the accu­mu­la­tion of macrophages, the pro­lif­er­a­tion of smooth mus­cle cells, and the depo­si­tion of cho­les­terol.” “As ath­er­o­scle­ro­sis pro­gresses, there is com­pen­satory expan­sion of the lumen that main­tains lumen size rather con­stant.… It is the acute throm­bo­sis, not arte­r­ial lumen steno­sis that is respon­si­ble for infarc­tion in most cases.” (5)

The REAL Cause of Heart Dis­ease
In 2002, the British Jour­nal of Med­i­cine pub­lished a very con­tro­ver­sial study about what researchers have coined the “Hound of the Baskervilles Effect.” After exam­in­ing death cer­tifi­cates from 209,908 Chi­nese and Japan­ese Amer­i­cans and 47,328,762 white Amer­i­cans they dis­cov­ered that, “Car­diac mor­tal­ity increases on psy­cho­log­i­cally stress­ful occa­sions.” (6)

The famed 2004 INTER­HEART study pub­lished in the world renown jour­nal Lancet con­firmed that stress is actu­ally the pri­mary cause of heart dis­ease. Sys­tem­at­i­cally eval­u­ated 15,152 cases of acute myocar­dial infarc­tion (heart attack) in 52 coun­tries and dis­cov­ered that the REAL cause of heart dis­ease is not cho­les­terol, but mul­ti­ple fac­tors. Accord­ing the the study,

Abnor­mal lipids, smok­ing, hyper­ten­sion, dia­betes, abdom­i­nal obe­sity, psycho-social fac­tors, con­sump­tion of fruits, veg­eta­bles, and alco­hol, and reg­u­lar phys­i­cal activ­ity account for most of the risk of myocar­dial infarc­tion world­wide in both sexes and at all ages in all regions. This find­ing sug­gests that approaches to pre­ven­tion can be based on sim­i­lar prin­ci­ples world­wide and have the poten­tial to pre­vent most pre­ma­ture cases of myocar­dial infarc­tion.” (7)

Out of all of these risk fac­tors, research sug­gests that psy­cho­log­i­cal stress is actu­ally the #1 cause. Per­sis­tent severe stress makes it two and a half times more likely that an indi­vid­ual will have a heart attack com­pared to some­one who is not stressed.” Stress and depres­sion com­bined increase the risk “three­fold!” (7)

So, if stress is the pri­mary cause of heart dis­ease, it makes one won­der why do MD’s dole out statins like candy, doesn’t it?

The Statin Con­tro­ver­sary
More than 25 years has come and gone since the first com­mer­cial statin was pro­duced. In a world which gen­er­ally acknowl­edges bad habits in respect of eat­ing and exer­cise, statins were going to pro­vide the ulti­mate solu­tion to a fright­en­ing and esca­lat­ing prob­lem: Pre­ma­ture death from heart fail­ure and stroke.

Through­out recent his­tory many ‘mir­a­cle’ med­ica­tions were claimed to have been dis­cov­ered. Freud found it in his beloved ‘Coca’ and AZT was to effec­tively pro­long the lives of HIV and Aids suf­fer­ers. Nitrous oxide went from being a recre­ational stim­u­lant to global accep­tance as anaes­the­sia and lev­odopa was unveiled to the procla­ma­tion it would reverse all symp­toms of Parkinson’s disease.

Some would sim­ply lift the spir­its, oth­ers were sanc­ti­fied as noth­ing less than mirac­u­lous in their abil­ity to treat an ill­ness with­out side effects. The quest to find a drug, which pro­duces noth­ing less than healthy nor­mal­ity and a return to equi­lib­rium has long since occu­pied the mind of man. Yet, all were dis­cov­ered sub­se­quently to be, in some mea­sure, flawed.

It seems that sci­ence has a his­tory of mak­ing huge leaps and procla­ma­tions – shortly before falling flat on its face.

This makes me won­der are statins set to join the long list of med­ical mir­a­cles, which turned out to be not quite so miraculous?

As the statins and cho­les­terol con­tro­versy gains momen­tum, and despite the best efforts of the phar­ma­ceu­ti­cal indus­try, faith in this mod­ern med­ical mir­a­cle con­tin­ues to undergo a bar­rage of ques­tion­ing under the ban­ner of mistrust.

In this arti­cle, just like in my prac­tice, I don’t tell any­one to take or to not take statins. My goal is to see you healthy enough so that you can live freely with­out them! Clearly, these are drugs and your response to them need to be mon­i­tored care­fully by your MD, whether you are start­ing them up or com­ing off of them.

But how have we arrived at this moment?

Cho­les­terol and Statins – Their His­tory
In 1910, Adolf Win­daus reported that ath­er­o­scle­rotic plaques con­tained a higher con­cen­tra­tion of cho­les­terol than those in nor­mal aor­tas. (8) In 1939, a Nor­we­gian clin­i­cian, Carl Muller was the first to describe a genetic trait in some fam­i­lies where high cho­les­terol lev­els were cited as the pos­si­ble cause of early death from heart fail­ure. (9)

Those rel­a­tively basic obser­va­tions ulti­mately sealed the fate of cho­les­terol for the next 7 decades. Cho­les­terol became the bad guy. Essen­tially it became the scape­goat for plaques in aor­tas, which is a major cause of heart attacks and strokes. Some peo­ple, those with a genetic pre­dis­po­si­tion to the con­di­tion, which became known as famil­ial hyper­c­ho­les­terolemia, were at greater risk than most. Or so it was thought…

For the remain­der of peo­ple a life-lesson was about to com­mence. Since cho­les­terol is either syn­the­sized in the body or obtained through diet, a med­ical leap of faith was made to explain how patients were not genet­i­cally pre­dis­posed develop heart dis­ease. And diet had to be the cause. We were all eat­ing the wrong things, right?

Sales of but­ter plum­meted and mar­garine rock­eted as peo­ple rushed to avoid the dreaded sat­u­rated fats. Super­mar­ket shelves became stacked with prod­ucts, which were low fat, cho­les­terol free and “healthy.” Yet, deaths from heart fail­ure con­tin­ued to rise.

That was, of course, until statins rode into town in Sep­tem­ber 1987. (10) The valiant war­rior, Lovas­tatin had arrived and, appar­ently, just in the nick of time. Here came the solu­tion to a cen­tury old prob­lem. Statins were going to lower cho­les­terol lev­els and save many from an early grave.

Yet, still today, the jury is out. Although praised to con­tribute to reduc­ing heart attacks and strokes, the research below shows that this med­ica­tion, for the major­ity, pro­vides lit­tle ben­e­fit at best. The side effects for the most part, main­tain a happy sta­tis­ti­cal equi­lib­rium with the ben­e­fits and, in many cases, far out­weigh any pos­i­tive effects. Mat­ters are now being made worse by the ris­ing tidal wave of opin­ion that cho­les­terol may not be the bad guy after all.

Using a Sledge­ham­mer to Crack a Nut?
Statins are used in two dif­fer­ent ways. Firstly, they are used to treat those with a pre-existing heart con­di­tion, which is known as “sec­ondary pre­ven­tion.” In such patients there are poten­tial ben­e­fits, which may, for some, out­weigh the risks asso­ci­ated with side effects. Research has shown that the main ben­e­fits are to men under the age of 80 with a pre-existing heart con­di­tion. (11) Even in such cases, however,

96% of patients with a pre-existing heart con­di­tion see no ben­e­fit from tak­ing statins.

In what is termed “pri­mary pre­ven­tion,” where patients have no pre-existing con­di­tion, the gains are less notice­able. In such cases the same study found that 98% of patients expe­ri­enced no ben­e­fit and only 1.6% over a 5-year period had a heart attack pre­vented. The per­cent­age that had a stroke averted falls fur­ther to 0.4%. (13)

Yet the num­ber of peo­ple who suf­fered mus­cle dam­age as a direct result of tak­ing statins, 10%, is exactly the same whether receiv­ing treat­ment as either pri­mary or sec­ondary patients. (13) In the major­ity of cases these patients would have been per­fectly healthy prior to being pre­scribed statins. Even more alarm­ingly, 1.5% of the pri­mary pre­ven­tion patients devel­oped dia­betes as a direct result of the med­ica­tion. (13)

The ques­tion patients should ask is: Does the pos­si­ble sta­tis­ti­cal pre­ven­tion of one seri­ous ill­ness jus­tify the risk of devel­op­ing another?

Sta­tis­tics reveal that nearly 1 in 5 patients receiv­ing statin treat­ment are between 45 – 64 years old. (14) This indi­cates that a large per­cent­age of peo­ple who are take statins are still of work­ing age and most likely in employ­ment. The eco­nomic impli­ca­tions of increas­ing sick days, or worse, end­ing employ­ment, due to treatment-induced ill­nesses are rarely con­sid­ered or cal­cu­lated. Nei­ther are the reduc­tions in qual­ity of life inflicted on a pre­vi­ously healthy patient.

Side Effects of Statins in Healthy People

Gen­er­ally, the fol­low­ing side-effects can be con­sid­ered “com­mon,” which means they affect up to 1 in 10 peo­ple and are proven to do so in most stud­ies: (15)

Nose bleeds
Sore throat
Feel­ing nau­seous
Mus­cle and joint pain
Runny or blocked nose
Increased blood sugar level
Increased risk of dia­betes
The uncom­mon side effects, which means up to 1 in 100 peo­ple can be affected, are reported as:

Weight gain
Loss of appetite
Mem­ory prob­lems
Ring­ing in the ears
Insom­nia or night­mares
Periph­eral neu­ropa­thy (tin­gling or loss of sen­sa­tion in hands and feet)
Skin prob­lems
Phys­i­cal weak­ness
Rare side effects, which affect only 1 in 1000 peo­ple, include:

Bruis­ing or bleed­ing eas­ily
Visual dis­tur­bances
Many of these side effects, whether they are com­mon, uncom­mon or rare, can result in per­ma­nent injury or restrict the patient in car­ry­ing out every­day activ­i­ties. Dri­ving and oper­at­ing machin­ery, for exam­ple, is rec­om­mended to be sus­pended in rela­tion to sev­eral. Qual­ity of life notwith­stand­ing, to a work­ing­man or woman this can seri­ously dis­rupt employ­ment or restrict poten­tial career prospects.

Statins and the Cho­les­terol Con­tro­versy Com­pounded
The con­tro­versy regard­ing statins and cho­les­terol not only con­tin­ues to rage but the flames are being con­tin­u­ously fanned. Sta­tis­tics, ter­mi­nol­ogy and phrase­ol­ogy com­pound the confusion.

Two years ago, Pro­fes­sor Kausik Ray gave an inter­view (16) in which he declared statins could be ben­e­fi­cial. He said, “…high cho­les­terol lev­els are related to coro­nary heart dis­ease.” A clear enough state­ment surely, but is the choice of words misleading?

Surely the rel­e­vance relates not to whether they are “related,” but are high cho­les­terol lev­els the “cause”? If they are not, the treat­ment reg­i­mens grow increas­ingly suspicious.

This is a fine exam­ple of how expert state­ments can be mis­lead­ing or mis­in­ter­preted. It is also a fine exam­ple of how such state­ments and opin­ion lit­ter the research and find­ings rel­a­tive to the risks and ben­e­fits of statin treat­ments par­tic­u­larly in respect of those “need­ing” pri­mary pre­ven­ta­tive medication.

The Cen­ters for Dis­ease Pre­ven­tion and Con­trol (CDC) have made some appar­ently infor­ma­tive, if not con­fus­ing, state­ments about the issue of cholesterol.

Their “Facts” page informs us:

71 mil­lion Amer­i­cans (33.5%) have high LDL (low-​density lipopro­tein) or ‘bad’ cho­les­terol.” (17)
“Just over 13% of U.S. adults had high total cho­les­terol…” (18)
Should we be more wor­ried about LDL cho­les­terol than we are about total cho­les­terol? (Accord­ing to the CDC, it’s def­i­nitely a more widely-​spread prob­lem.) Not so much, accord­ing to other sources – includ­ing the same sources which orig­i­nally declared LDL lev­els to be the root of all evil:

In Novem­ber 2013 the lat­est guide­lines from the ACC/​AHA (Amer­i­can Heart Asso­ci­a­tion and Amer­i­can Col­lege of Car­di­ol­ogy) were pub­lished. (19)

The guide­lines, although run­ning to over 80 pages, appear to make a clear U-​turn when it comes to cho­les­terol lev­els, or at least in clin­i­cians rely­ing on such indi­ca­tors as being reli­able in iden­ti­fy­ing the poten­tial of future ill­ness. Sur­pris­ingly, the new ACC/​AHA guide­lines have no set tar­gets for LDL lev­els. Instead, doc­tors are rec­om­mended to use the new on-​line cal­cu­la­tor designed for assess­ing whether or not patients should be pre­scribed statins. It seems that lifestyle and over­all diet were now to be taken into con­sid­er­a­tion when assess­ing poten­tial for treatment.

How­ever, just two days after the guide­lines were pub­lished, the cal­cu­la­tor itself was found to be flawed.

Despite shift­ing the focus away from using LDL as the defin­i­tive guide­line, still the para­me­ters con­tinue to grow and encap­su­late an increas­ing num­ber of the pop­u­la­tion. The UK fol­low­ing on the heels of the US, pro­duced draft guide­lines stat­ing that peo­ple with a 20% risk of devel­op­ing CDV in the next 10 years, should be reduced to include peo­ple with only a 10% risk. (20) This brings them more into line with the US who state the statin thresh­old should be 7.5% for a 10-​year risk period. (20) This basi­cally trans­lates into more peo­ple tak­ing aggres­sive drugs.

The guide­lines from both the US and the UK advise that more patients should be put on “high inten­sity” treat­ment. This means the switch from treat­ing patients with sim­vas­tatin, a medium inten­sity treat­ment, to ator­vas­tatin, which is high inten­sity. Clearly, the impact of even medium inten­sity treat­ments already has sig­nif­i­cant side effects. The impli­ca­tions are that, should patients have the level of med­ica­tion increased, and then the side effects would increase pro­por­tion­ately. Yet, the main impe­tus for increas­ing med­ica­tion in this man­ner is one of “cost sav­ing.” The cost sav­ings one would pre­sume have only been cal­cu­lated rel­a­tive to reduc­ing treat­ing patients with heart fail­ure, not by incor­po­rat­ing costs relat­ing to treat­ing the side effects of the treatment!

In fact, we have seen for years that one of the main issues relat­ing to the statins and cho­les­terol con­tro­versy is one of money — lots of it! In 2009 total rev­enues exceeded $25 bil­lion. (21) At the last count, over 25mil­lion Amer­i­cans were on statins (22) and this was with­out tak­ing into con­sid­er­a­tion the effects of new guide­lines. The indi­ca­tions are that the fig­ures will in future, dou­ble. (22)

The rev­enues, of course, do not include the prof­its phar­ma­ceu­ti­cal com­pa­nies make treat­ing the side effects of statins. For them, the num­bers are clear. The more pre­ven­ta­tive treat­ment they pro­vide, the richer they become. The ben­e­fits to patients how­ever are less obvious.

The Ben­e­fits of Cho­les­terol
Cho­les­terol is essen­tial to the human metab­o­lism. It is required for Vit­a­min D syn­the­sis, the diges­tion of fats through bile salts; it forms part of each and every cell. It reg­u­lates numer­ous hor­mones, is a pow­er­ful antiox­i­dant and assists in repair­ing injuries. If cho­les­terol lev­els fall too low patients risk neu­ro­log­i­cal or immune dysfunction.

The risks, inci­den­tally, are certainties.

The human body can no more func­tion on low lev­els of cho­les­terol than it can on low lev­els of blood.
Although amend­ments have been made to guide­lines, in most cases advis­ing that diet and lifestyle should be taken into account in addi­tion to lab­o­ra­tory test results, the med­ical estab­lish­ment is con­tin­u­ing to incor­po­rate an increas­ing num­ber of peo­ple into the bound­aries of need­ing statin treat­ments. As the prob­lems with the US on-​line cal­cu­la­tor clearly show, the issues have not been deeply thought through prior to widen­ing the net of treat­ment. Noth­ing, it seems, is either cer­tain or clear.

Until the sci­en­tific com­mu­nity inde­pen­dently inves­ti­gate all the pros and cons of the statins and cho­les­terol rela­tion­ship, there can be lit­tle doubt the con­tro­versy will con­tinue to esca­late and, quite pos­si­bly, result in increas­ing mis­trust of Big Pharma and the pow­ers that be.

For­tu­nately, there is a grow­ing body of MD’s prac­tic­ing func­tional and inte­gra­tive med­i­cine, and work­ing to keep patients well with­out the uses (or pres­sures) of mod­ern med­i­cine. In my own prac­tice, I always enjoy the abil­ity to refer my patients to these types of doc­tors, and to other doc­tors within the nat­ural health world. I’ve seen count­less indi­vid­u­als improve their sit­u­a­tions and restore their health through bet­ter lifestyle, with­out neg­a­tive consequences.

Writ­ten by Dr. BJ Hardick

Research sup­port by Dr. Eric Zielinski