For those who aren’t sure the
conventional health community is wholly in support of individual health
when it comes to cholesterol levels — which in some cases still adheres
to the story line that too much cholesterol increases the risk of heart
disease — you’re right to be concerned.
Taking a global view of what cholesterol is and how it affects your
body is a smarter way to approach it than the simple “cholesterol kills”
narrative that’s been the drum beat for so many years.
Cholesterol, the soft, waxy substance found in every cell in your
body, is used to produce several of your body’s vital functions,
including those that involve hormones and vitamin D. About 75% of it is
made by your liver and the remainder is derived from the foods you eat;
25% is in your brain.
There are two types: High-density is the first. It is also known as
HDL, or the “good” kind that keeps cholesterol away from your arteries
and removes it from your arteries. The second type is low density
lipoprotein, or LDL. LDL is the “bad” kind that can build up in your
arteries, form plaque that narrows your arteries and form a clot. This
can then make its way to your heart or brain and cause either a heart
attack or stroke.
The American Heart Association (AHA)1
now recommends that you balance your levels at about 150 (milligrams
per deciliter) (mg/dL). According to old, unfounded science, your total
cholesterol — the sum of all the cholesterol in your body — is not a
gauge of your heart disease risk. When your levels are measured,
elevated levels of triglycerides
are also taken into account. According to Børge Nordestgaard, from the
University of Copenhagen and Copenhagen University Hospital:
“So far, both cardiologists and [physicians] have focused mostly
on reducing LDL cholesterol, but in the future, the focus will also be
on reducing triglycerides and remnant cholesterol.”2
Does it matter what kills you?
In a commentary posted on Mission.org, a rhetorical question is
presented: With all the ways you can die, does it really matter what
kills you? On one hand, “If you’re dead, you’re dead, no matter from
what,” so it seems silly to “focus on changing something that lowers the
risk of death from one cause only to raise that risk from another.”3
It’s an astute observation when you read studies showing conclusively that cholesterol has very little to do with heart disease.
Even more importantly, cholesterol is crucial for your health. If it’s
too low, then eventually, your hormones, disease risk, cell signaling
pathways, and yes, your heart, will suffer. In fact, new research shows
that a too-low LDL level could put you at higher risk for a stroke.4
The Dietary Guidelines Advisory Committee (DGAC), which reviews the
Dietary Guidelines for Americans every five years, investigated the
issue. The 2015-2020 guidelines noted:5
“While adequate evidence is not available for a quantitative
limit for dietary cholesterol in the 2015-2020 Dietary Guidelines,
cholesterol is still important to consider when building a healthy eating style. In fact, the Dietary Guidelines states that people should eat as little dietary cholesterol as possible.”
Yet, even though that’s what it says on the government’s
ChooseMyPlate public website, it’s obvious the committee at some point
“flipped” its narrative entirely by acknowledging at a Dietary
Guidelines Advisory Committee meeting that “cholesterol is not
considered a nutrient of concern for overconsumption.”6
It’s no wonder people are confused about where cholesterol fits in
your diet, when they send one message to the public and a completely
different one to their own group at an advisory committee meeting.
Interestingly, that statement was made nearly five years ago, but
information on the importance of cholesterol is nearly two decades old.7 As the Honolulu Heart Program study published in The Lancet in 2001 states:
"Our data accord with previous findings of increased mortality in
elderly people with low serum cholesterol, and show that long-term
persistence of low cholesterol concentration actually increases risk of
death."
The narrative challenges those who insist that eating foods that contain fat of any kind — saturated fats and trans fats
alike — are harmful. Many who make this claim also maintain that
“Saturated fat is a bad fat because it raises your LDL level more than
anything else in your diet.”8 However, as explained in the Mission.org article:
“While total cholesterol is a poor if not utterly worthless risk
marker for heart disease, doctors have focused on it to the exclusion of
how it might affect other causes of death. It does you little good to
save yourself from heart disease if it means that you increase your risk
of death from cancer. All-cause mortality — death from anything — is
the most appropriate measure to use when looking at risk factors.”9
The best measure for risk factors
“Death from anything” may be a clearer term for the one so often used
in clinical settings: All-cause mortality. Either way, as quoted by the
following study, that’s what the latest research says is the best
measure for the factors that increase the risk of what eventually and
most likely will take someone’s life.
When it comes to your risk of death from heart disease, there’s much more evidence that inflammation
is at the bottom of heart disease rather than high cholesterol, just as
it is for a number of other serious diseases. If you want to find what
might help you live longer, that’s the premise of a lengthy Japanese
study published in the Annals of Nutrition & Metabolism. As the
featured study, it notes that regardless of someone’s age, people with
higher cholesterol live longer:
“Overall, an inverse trend is found between all-cause mortality
and total (or low density lipoprotein [LDL]) cholesterol levels:
mortality is highest in the lowest cholesterol group without exception.
If limited to elderly people, this trend is universal. As discussed in
Section 2, elderly people with the highest cholesterol levels have the
highest survival rates irrespective of where they live in the world …
Based on data from Japan, we propose a new direction in the use
of cholesterol medications for global health promotion; namely,
recognizing that cholesterol is a negative risk factor for all-cause
mortality and re-examining our use of cholesterol medications
accordingly.”10
After showing that people of all ages with higher cholesterol levels
live longer in Japan, in support of these conclusions, similar
conclusions were made by a study based in the Netherlands and published
in BMJ in 2016.11
The study adjusted for several heart risk factors like smoking, high blood pressure
and a history of diabetes melllitus. Participants were placed in groups
depending on whether their cholesterol levels were low, medium or high,
and those with the highest cholesterol levels were found to have the
lowest death rates.
The title of the BMJ review reveals the outcome — there was a “lack
of an association or an inverse association between
low-density-lipoprotein cholesterol and mortality in the elderly.”12
In short, older people with high LDL cholesterol generally live just
as long as — and may even outlive — people with low LDL, which begs the
question of how the current cholesterol theory was arrived at in the
first place. At the very least, the study authors imply the cholesterol
question should at least be re-evaluated. It concluded:
“Our review provides the basis for more research about the cause
of atherosclerosis and (cardiovascular disease) and also for a
re-evaluation of the guidelines for cardiovascular prevention, in
particular because the benefits from statin treatment have been
exaggerated.”13
One of the first studies published with information suggesting that
high cholesterol is not as heart-damaging as once thought was the
Honolulu Heart Program,14
offering further evidence that higher cholesterol levels may be heart
protective. The authors concluded by questioning whether there is
“scientific justification for attempts to lower cholesterol to
concentrations below 4-65 mmol/L in elderly people,” adding that
“prudence dictates a more conservative approach in this age group.”15
Can high cholesterol really be heart protective?
Perhaps the question that would get to the point quicker is to ask
why the Japanese study infers that people with low versus high
cholesterol die sooner? The Mission offers referenced studies that show a
few factors that could be weighing in:
• Cholesterol may protect against
infections and atherosclerosis, as “the many observations that conflict
with the LDL receptor hypothesis, may be explained by the idea that high
serum cholesterol and/or high LDL is protective against infection and
atherosclerosis.”16
• Cholesterol may protect against cancer,
although in previous cases where low cholesterol was linked to cancer,
exclusions were made to tip the scales, such as excluding possible prior
drug treatment, namely clofibrate, a popular cholesterol-lowering drug
before statins, by subjects — leaving the question open as to whether it
was the low cholesterol that caused the cancer, or the drug treatments
that contributed to it.17
• Low cholesterol (180 mg/dL and lower)
and violence in psychiatric patients have been linked. When patients in a
long-term psychiatric hospital with a history of seclusion or
restraints were compared with other patients, there was a “highly
significant and strong association between lower cholesterol levels and
violent behavior.” The authors did caution, however, that cholesterol
levels should not be used to predict violence.18
• There’s also an association between low
cholesterol and suicide dating back more than a decade, as researchers
found that people in the lowest quartile of cholesterol concentration
had more than six times the suicide rates than those in the highest
quartile.19
It should be noted that at least one study in Japan20 determined that high cholesterol and suicide were connected.
But, in fact, numerous recent studies have corroborated the earlier ones connecting low cholesterol to suicide,21
with various findings: For example, one found that low triglycerides,
reduced BMI and waist circumference, specifically, but not total
cholesterol, were connected to a higher risk of suicide;22 while a 2019 study23 found that “low cholesterol is associated with aggression in suicide attempters.”
So what about statins?
Significantly, the authors of an Annals of Nutrition & Metabolism
study didn’t hold back when drawing conclusions regarding why the
cholesterol conundrum has gone on so long when the evidence is so clear:
“For the side defending this so-called cholesterol theory, the amount
of money at stake is too much to lose the fight.”24
The Annals of Nutrition & Metabolism study’s introduction
mentions a medical practitioner who advocated statins to his patients to
drive down cholesterol until he read the Scandinavian Simvastatin
Survival Study,25
in which 4,444 patients with different types of heart disease were
given simvastatin — which is touted to be a safe, long-term treatment to
improve survival in cardiovascular heart disease patients.
As it turns out, the claim that high cholesterol causes heart disease and death is incorrect; it is, in fact, the opposite. Three reviews26,27,28
supporting the cholesterol hypothesis were found to contain altered
data to support their conclusions, according to Expert Review of
Clinical Pharmacology, in which it is noted that:
“Our search for falsifications of the cholesterol hypothesis
confirms that … the conclusions of the authors of the three reviews are
based on misleading statistics, exclusion of unsuccessful trials and by
ignoring numerous contradictory observations.”29
Drugs.com30
contributors state that the 35 million people on statins often
experience myriad side effects. Liver damage, for instance, is said to
be “rare,” implying that ongoing liver tests while taking statins likely
aren’t necessary. Some doctors, however, say you’ll need a baseline
liver function test beforehand. The most common side effects of statins
are:
And, just in case you needed another source to implicate statins’
role in psychiatric problems, an April 2018 study found that lowering
cholesterol levels in men could bring about changes in nerve cell
membranes and behavior in men:
“Men seem to be more sensitive to low cholesterol levels as the
association between low cholesterol levels and aggression is found
mostly in men,” the authors said.” … “Lowering cholesterol levels with
statins brings about several changes in the serotonergic system, nerve
cell membrane microviscosity and behaviour, and needs to be done with
precaution in susceptible individuals.
Cholesterol levels could serve as a biological risk marker for
violence and suicidal tendencies in psychiatric patients with depression
and schizophrenia.”
More studies and reviews on statin use
Rather than pointing patients in the direction of finding dietary solutions, including eating both the whites and the yolks when having eggs, and ditching processed vegetable oils in favor of healthy cooking oils like coconut oil, olive oil and avocado oil,
Harvard Health Medical School recently updated an article on how to
“manage” muscle pain from taking statins, perpetuating the cholesterol
myth. They stated:
“If you’re not taking a statin now, you may well be soon. These
medications are commonly prescribed to lower ‘bad’ LDL cholesterol and
have been shown to reduce the risk of heart attack, stroke, and death.
They are routinely recommended for people who have cardiovascular
disease and for many people ages 40 to 75 who don't have cardiovascular
disease but have at least one risk factor (high blood pressure, high
cholesterol, diabetes, or smoking) and a 7.5% or greater risk of a
stroke or heart attack in the next decade.
Moreover, recent research indicates that they may benefit high
risk individuals over age 75 as well … Taking a statin may give you some
assurance that you're doing all you can to avoid heart attack and
stroke …”31
Exercising, losing weight, adopting healthy eating habits and including vitamin D and coenzyme Q10 (CoQ10)
supplements in your diet are all good strategies for maintaining your
cholesterol levels. Unfortunately, the common suggestion for alleviating
muscle pain due to statin use is more of the same — just try taking a
lower dose or switching to another statin prescription.32
As if that weren’t enough, experts say statins may impair your memory
and cause amnesia, a possibility real enough to call for a warning on
the labels of prescriptions.33 Statin use may precipitate a higher risk of developing cataracts34
and it “significantly” increases the likelihood of raising the fasting
glucose levels of non-diabetics, as well as inducing high blood sugar.35
In another review of the adverse effects of statins, it was noted
that “an array of additional risk factors for statin AEs [adverse
events] are those that amplify (or reflect) mitochondrial or metabolic
vulnerability, such as metabolic syndrome factors, thyroid disease, and
genetic mutations linked to mitochondrial dysfunction.”36
Given the false information saying cholesterol is at fault for
causing heart-related disease, the continued prescriptions being handed
out to patients for statins, and the side effects they cause, it’s clear
why, in their introduction, the authors of the Annals of Nutrition
& Metabolism study stressed:37
“This, we believe, marks the starting point of a paradigm shift
in not only how we understand the role cholesterol plays in health, but
also how we provide cholesterol treatment … Our purpose in writing this
supplementary issue is to help everyone understand the issue of
cholesterol better than before, and we hope that we lay out the case for
why a paradigm shift in cholesterol treatment is needed, and sooner
rather than later.”
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