Are Cholesterol Guidelines “Misguided?”

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When the Washington Post delivered the message that “The U.S. government is poised to withdraw longstanding warnings about cholesterol” on February 10, 2015, 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: 

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,

(12)

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
  • Headache
  • Runny or blocked nose
  • Increased blood sugar level
  • Increased risk of diabetes
  • Constipation
  • Indigestion
  • Flatulence
  • Diarrhea

The uncommon side effects, which means up to 1 in 100 people can be affected, are reported as:

  • Vomiting
  • Weight gain
  • Loss of appetite
  • Memory problems
  • Ringing in the ears
  • Dizziness
  • Insomnia or nightmares
  • Peripheral neuropathy (tingling or loss of sensation in hands and feet)
  • Hepatitis
  • Pancreatitis
  • Skin problems
  • Fatigue
  • Physical weakness

Rare side effects, which affect only 1 in 1000 people, include:

  • Bruising or bleeding easily
  • Visual disturbances
  • Jaundice

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 Control and Prevention (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 25 million 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. 

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.

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Dr. B.J. Hardick

About Dr. B.J. Hardick

Raised in a holistic family, Dr. B.J. Hardick is an organic food fanatic, green living aficionado, and has spent the majority of his life working in natural health care. In 2009, he wrote his first book, Maximized Living Nutrition Plans, which has now been used professionally in over 500 health clinics. Dr. Hardick regularly blogs healthy recipes and holistic health articles on his own website, DrHardick.com, and speaks to numerous professional and public audiences every year. In his spare time, he invests his keen interest in sustainable living into urban development in his hometown of London, Ontario. Learn More