The Great Cholesterol Myth (22 page)

Cholesterol is a hormone factory.
Cholesterol is actually the parent molecule for the whole family of hormones known as
steroid hormones
. These hormones include cortisol (known as the fight-or-flight hormone) and the entire family of sex steroids, including estrogens, progestogens, and testosterone. (No wonder statins produce such serious sexual side effects!)

Cholesterol is used by the body to synthesize bile acids.
Bile acids are vitally important for the digestion of fat. The acids are synthesized from cholesterol and then secreted into the bile. Bile acids are so important to the body that the body holds on to most of them. It keeps them from being lost in the feces by causing them to be reabsorbed from the lower intestine, put into a kind of “metabolic recycling” container, and taken back to the liver. Still, even with its best efforts, the body loses some bile acids. To make up for this, the liver synthesizes approximately 1,500 to 2,000 mg of new cholesterol a day (that’s about seven to ten times the amount in a large egg). Clearly, the body thinks you need that cholesterol.

Cholesterol is an essential component of all the cell membranes in the body.
It’s especially important in the membranes of the brain, the nervous system, the spinal cord, and the peripheral nerves. It’s incorporated into the myelin sheath, a kind of insulation or “cover” for the nerve fibers that facilitates nerve
impulse transmission. And, as we’ve already seen, cholesterol is an integral part of the lipid raft, essentially allowing for cellular communication. (That’s why there are so many cognitive problems associated with aggressive cholesterol lowering.) Cholesterol is also important for stabilizing cells against temperature changes.

Cholesterol is important for the immune system.
Cholesterol has an important connection to the immune system. Research has shown that human LDL (the so-called “bad” cholesterol) is able to inactivate more than 90 percent of the worst and most toxic bacterial products.
³⁵

A number of studies have linked low cholesterol to a greater risk of infections. One review of nineteen large, peer-reviewed studies of more than 68,000 deaths found that low cholesterol predicted an increased risk of dying from respiratory and gastrointestinal diseases, which frequently have an infectious origin.
³⁶
Another study that followed more than 100,000 healthy individuals in San Francisco found that those who had low cholesterol at the beginning of the fifteen-year study were far more likely to be admitted to the hospital because of an infectious disease.
³⁷
And an interesting finding from the MRFIT study showed that sixteen years after their cholesterol was first checked, the group of men whose cholesterol level was 160 mg/dL or lower was four times more likely to die from AIDS than the group of men whose cholesterol was higher than 240 mg/dL!
³⁸

We make vitamin D from cholesterol.
It’s almost impossible to overstate how important the cholesterol–vitamin D connection is. Vitamin D, which is actually a hormone, not a vitamin, is made from cholesterol in the body. If you lower cholesterol indiscriminately, it stands to reason that you may negatively affect vitamin D levels. And that’s hardly insignificant.

Virtually every health practitioner worth his or her salt will tell you that massive numbers of people in the United States (and probably the world) have less than optimal vitamin D levels. According to the Centers for Disease Control and Prevention, “only” 33 percent of the U.S. population is at risk for either vitamin D “inadequacy” or vitamin D “deficiency,”
³⁹
but the levels considered “sufficient” are still being debated, and “sufficient” is hardly “optimal.”

In 2010, the Life Extension Foundation conducted a survey of its members—a self-selected sample of people who really care about these things and pay particular attention to their health, blood tests, and supplementation—and found that even in this highly health-conscious population, a whopping 85 percent had blood tests with vitamin D levels below 50 ng/mL, considered the low end of “optimal” (50 to 80 ng/mL).
⁴⁰

Why does this matter? Because there is compelling research that links less than optimal levels of vitamin D with heart disease, poor physical performance, osteoporosis, depression, cancer, difficulty in losing weight, and even all-cause mortality. Vitamin D is so important that Dr. Gregory Plotnikoff, medical director of the Penny George Institute for Health and Healing, Abbott Northwestern Hospital in Minneapolis, recently commented, “Because vitamin D is so cheap and so clearly reduces all-cause mortality, I can say this with great certainty: Vitamin D represents the single most cost-effective
medical intervention in the United States.”
⁴¹

Undoubtedly, there are multiple reasons why so many people are walking around with suboptimal levels of vitamin D, not the least of which is that we are so darn sun-phobic that we now slather SPF 90 on our skin just to go to the grocery store. But is it a coincidence that vitamin D deficiencies and insufficiencies are showing up all over the place at the same time that 11 million to 30 million Americans are on statin drugs, the purpose of which is to lower the very molecule that gives “birth” to this vitally important nutrient?

So what to make of all this? Therapeutics Initiative—a group whose mission is to provide physicians and pharmacists with up-to-date, evidence-based, practical information on prescription drug therapy—wondered the same thing.

Therapeutics Initiative was established in 1994 by the Department of Pharmacology and Therapeutics in cooperation with the Department of Family Practice at the University of British Columbia. To reduce bias as much as humanly possible, it made Therapeutics Initiative wholly independent from the government, the pharmaceutical industry, and other vested interest groups. A telling statement on the website of Therapeutics Initiative sums up the group’s mission: “We strongly believe in the need for independent assessments of evidence on drug therapy to balance the drug industry–sponsored information sources.”
⁴²

So it would be interesting to see what Therapeutics Initiative has to say about these statin trials, wouldn’t it?

In Therapeutics Letter #48, an issue of its bimonthly letter series, the group tackled the question: “What is the overall health impact when statins are prescribed for primary prevention?” (Remember, primary prevention refers to the use of statin drugs to prevent a first heart attack or coronary “incident,” whereas secondary prevention refers to the use of statin drugs to prevent a second heart attack.)

Interesting question, indeed. The scientists at Therapeutics Initiative analyzed five of the major statin trials—the PROSPER, ALLHAT-LLT, and ASCOT-LLA trials mentioned above, plus two published earlier.
⁴³
Taken together, these five trials involved an overall population that was 84 percent primary prevention and 16 percent secondary prevention. In the pooled data, the statins reduced cardiovascular measures—total myocardial infarction (heart attack) and total stroke—by 1.4 percent. Yes, you read that right. Less than a 1.5 percent reduction in the very thing the drugs are supposed to prevent (heart attacks and strokes). “This value indicates that 71 mostly primary prevention patients would have to be treated for three to five years to prevent one such event,” wrote the authors. (We wonder how many patients would eagerly sign on for statin therapy if they were asked the following question: Would you be willing to take an expensive drug that has the possibility of serious side effects for three to five years in order to reduce your chances of a cardiovascular event by 1.4 percent?) Note that Therapeutics Initiative used the word “patients” in its analysis of the findings. Instead of the generic term “patients,” it should have used the more specific term
“men.” Commenting on the evidence of benefit for primary prevention in women, the researchers reported that in women—28 percent of the total population of the studies—when coronary events were pooled, they were not reduced by statin therapy. “The coronary benefit in primary prevention trials appears to be limited to men,” they wrote.

Dietary factors and therapeutic lifestyle changes have no side effects. They should be considered the first line of defense in preventive cardiology.

And do we need to remind you that the stated benefit was a mere 1.4 percent reduction in heart attacks and strokes?

It gets worse.

“The other measure of overall impact—total mortality—is available in all five trials, and is not reduced by statin therapy.”

In other words, there was a small reduction in cardiovascular deaths but a corresponding increase in deaths from other causes, resulting in an overall mortality benefit of, let’s see, that would be . . . zero. And although the researchers clearly acknowledged that paltry less-than-2-percent reduction in heart attack and/or stroke, they also pointed out that this cardiovascular benefit was not reflected in two measures of overall health impact: total mortality (overall death rate) and total number of serious adverse events. “Statins have not been shown to provide an overall health benefit in primary prevention trials,” the researchers concluded.
⁴⁴

A few years ago, John Abramson, M.D., author of
Overdosed America
, analyzed eight randomized trials that compared statin drugs with placebos. His findings and conclusions were published in a column in
The Lancet
, and they echo the findings and recommendations of the researchers at Therapeutics Initiative. Here’s what he wrote:

“Our analysis suggests that . . . statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years. High-risk men age 30 to 69 years should be advised that about 50 patients need to be treated for five years to prevent one event. In our experience, many men presented with this evidence do not choose to take a statin, especially when informed of the potential benefits of lifestyle modification on cardiovascular risk and overall health. This approach, based on the
best available evidence in the appropriate population, would lead to statins being used by a much smaller proportion of the overall population than recommended by any of the guidelines.”
⁴⁵

Millions of Americans will be taking statin drugs for decades, as recommended by the National Cholesterol Education Program’s (NCEP) guidelines, and long-term side effects will become apparent, creating a whole host of pathologic situations. What does all this confusion and controversy mean to practicing physicians and the patients for whom they care? Dietary factors and therapeutic lifestyle changes have no side effects. They should be considered the first line of defense in preventive cardiology.

Look, there’s not much doubt that statin therapy can significantly reduce the incidence of coronary morbidity and mortality for those who are at great risk of developing coronary artery disease.
⁴⁶
But as research continues to implicate inflammation as the major coronary risk factor, cholesterol recommendations by groups such as the NCEP may need to be modified. Ultimately, hopefully, the attention paid to cholesterol will be proportional to its importance as a causative factor in heart disease, which is to say, not much.

Rather than selecting treatment options as a technician or a computer would do and targeting cholesterol numbers alone, doctors owe it to their patients—and patients owe it to themselves!—to look further into these controversial issues before embracing potent drugs that might not truly serve the needs of the people for whom they’re being prescribed.

Although the use of statins in high-risk coronary patients—especially those with inflammatory markers—might be good medicine right now, overuse of these potent pharmacologic agents (that have both known and unknown side effects) for long-term use in otherwise healthy people is simply not justifiable.

CHAPTER 7

ASK YOUR TYPICAL MAINSTREAM DOCTOR ABOUT NUTRITIONAL SUPPLEMENTS
and the first thing you’re likely to hear is this: “There’s no good research showing they work.” Both of us have heard this refrain time and time again when we discuss nutritional medicine with our more conservative colleagues.

It’s not true.

You or your doctor can go online to the National Institute of Medicine’s library (
www.pubmed.com
), enter into the search box the name of virtually any vitamin or herb you can think of, and, depending on what you choose, hundreds to thousands of citations will pop up. So the problem isn’t an absence of research.

The problem is twofold. One, the conventional training of medical doctors in this country is highly biased toward pharmaceuticals. From the time they enter med school, doctors are courted by the pharmaceutical companies in myriad ways, some subtle, some not so subtle. Free lunches, symposiums, honorariums, consulting and lecturing contracts, vacations, perky pharmaceutical reps showing up at offices with the latest studies that show their products in a favorable light, free samples, and pens and prescription pads bearing the company’s name—all create a culture in which pharmaceuticals are the first choice in any treatment plan. (Most docs will tell you these practices have no influence on them or what they choose to prescribe, but the research tells a very different story.
¹
)

The second part of the problem is that much of the research on vitamins flies beneath the radar. Your overworked doctor barely has time to scan the abstracts of the
New England Journal of Medicine
every month, let alone dig deeply into the hundreds of studies that are published every year on vitamins and nutrients in journals like the
American Journal of Clinical Nutrition
. The vast majority of doctors in this country get no training whatsoever in nutrition, and those who do receive only the most rudimentary and superficial introduction to the subject. Put this together with the built-in medical school bias in favor of patent medicines, and it’s easy to see why doctors often fail to think of natural substances as legitimate tools that can help keep people healthy.