Professor Peter Gotzsche Fired from Cochrane Collaboration

Professor Peter Gotzsche, featured in Statin Nation II has recently been fired from the Cochrane Collaboration - the organisation he helped to establish.

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The Cochrane Collaboration is (or was) a highly respected international medical research organisation specialising in systematic reviews of the clinical evidence on a wide range of medical issues.

The idea of the Cochrane Collaboration was to provide a view of the clinical evidence that has not been tainted by commercial interests. This is a tall order since almost all of the data available to them has already been put through big pharma’s marketing machine - the raw material available to the Cochrane Collaboration (the data) has already been controlled or manipulated to some extent by industry. Nonetheless, Cochrane have been able to do some very useful analysis and publish influential and important reports.

Professor Peter Gotzsche has personally worked hard for decades to expose medical corruption and he has not held back in his strong criticisms of the pharmaceutical industry. Viewers of Statin Nation II will recall Gotzsche referring to pharmaceutical companies as engaging in “organised crime”.

We might expect that Gotzsche’s critique of big pharma is a good fit for Cochrane, and for a while it seems to have been. However, the Cochrane board recently voted 6 to 5 in favour of booting him out. And 4 of the 5 who wanted to keep him in have also since resigned.

In Statin Nation II, back in 2015, concerns were raised about the Cochrane Collaboration in relation to an apparent U-turn in their view of the clinical evidence for statins. Video clip below:

Later in the film during the interview with Professor Ebrahim, I asked for the best evidence that supports the notion that statins extend life expectancy. Professor Ebrahim referred me to the CTT data and the CTSU in Oxford- which has huge issues that have also been discussed in the film and elsewhere around the world. Also in another blog post available here.

It wasn’t just the all-cause mortality data that was a potential problem but also Professor Ebrahim’s unwillingness to accept that statins have significant adverse effects. It wasn’t possible to include all of this discussion with Professor Ebrahim in the film itself but the full one hour interview is included in the extras and complete package.

I have to say that during the making of Statin Nation II towards the end of 2014, after I interviewed Professor Ebrahim, I contacted Professor Gotzsche and urged him to take a look at the Cochrane reviews of statins. I was already concerned that the reputation of the Cochrane Collaboration would be tarnished by the inconsistencies in the published positions. Unfortunately, Professor Gotzsche took no action on this at that time and instead referred me back to Dr. John Abramson, who is featured in the first Statin Nation film but has nothing to do with Cochrane. I was disappointed by this at the time, and now I can’t help thinking that if action had been taken then, the Cochrane rot could have been postponed and Peter would still have his job.

Statin Corruption Exposed on Television in USA

Recently, Full Measure with Sheryl Attkisson aired a piece describing some of the financial ties between experts who set the cholesterol clinical guidelines and the pharmaceutical industry. This was something that was included in STATIN NATION way back in 2012 but its very rewarding to see larger parts of the media slowly catching up.

Full Measure is produced by and airs nationally on stations of the Sinclair Broadcast Group. According to their YouTube channel it is available in 43 million households via ABC, CBS, NBC, FOX, CW, MyTV, Univision and Telemundo affiliates. Since I am not in the U.S. I didn’t see the broadcast however, someone from the Statin Nation Facebook group kindly informed me about it.

Incidentally, most blog entries are posted on the Statin Nation Facebook page first, so if you use Facebook please follow the page: https://www.facebook.com/statinnation

Even if you are already aware of the issue concerning clinical guidelines it is still worth watching Sheryl Attkisson’s piece below, since there is an interesting short discussion with a statinator doctor who receives quite a lot of money for her views.


For reference, here is a very short excerpt from Statin Nation that first publicized this in 2012, also featuring Dr. Abramson!

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Important Papers in the War Against the War Against Cholesterol

There are a number of reasons why so many doctors believe in statins and the cholesterol hypothesis. One easily appreciable reason is that they simply haven’t been exposed to the huge amount of contrary data.

Doctors are predominantly shown data that has already been put through the pharmaceutical industry’s marketing machine and presented with sufficient twists and turns to create “unequivocal evidence”

During the last ten years I have attempted to show the contrary evidence in published articles, my books and documentary films. It is difficult to summarise all of this in a blog post however, I thought it might be useful to provide a reminder of some of the key scientific publications during the last decade that in particular should have caused our health authorities to sit up and rethink their position.

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These publications individually represent a significant challenge to the cholesterol hypothesis and the widespread use of statins.

It is Important to note that this is certainly not the totality of the evidence against the widespread use of statins - it is just a selection of papers that stand by themselves as a significant challenge. I have also, where possible, tried to select papers that are available free so anyone can have access to them.

Unfortunately, some of these reports have generally gone unnoticed and not received the same level of attention as the pharmaceutical industry’s sponsored information.

I have been working on this list during the last few days and coincidentally, the Guardian published a totally biased article yesterday specifically to attack those doctors who do not believe the dogma that cholesterol causes heart disease. This is not really a surprise since some time ago I met with the deputy editor of the Guardian and presented him with a free copy of Statin Nation. He instantly dismissed the information without even watching the film stating “that’s funny because my neighbour thinks statins are wonderful”. I don’t know who his neighbour is but I would be surprised if they are better qualified than the 18 internationally renowned experts interviewed for the Statin Nation documentaries. It goes without saying that the Guardian piece is completely full of inaccuracies and only serves as a mouthpiece for the pharmaceutical companies. How this article came about would also be intriguing to find out since it doesn’t mention any new studies, just an attack on those who dare question a false hypothesis.

The Ugly Side of Statins

(2013) This paper is written by Professor Sherif Sultan and his colleague Professor Niamh Hynes. Professor Sultan is one of the worlds leading vascular and endovascular surgeons. He is President of International Society Of Vascular Surgeons. This paper forms a concise and powerful systematic critique of the evidence for the widespread use of statins and also discusses statin adverse effects.

Download the PDF

The Cholesterol hypothesis: Time for the obituary?

(2011) This is an editorial written by Professors Tore Schersten, Paul J. Rosch, Karl E. Arfors, and Ralf Sundberg. There is no better summary of this editorial other than its own abstract:

“The cholesterol hypothesis links cholesterol intake and blood levels to cardiovascular disease. It has had enormous impact on health care and society during decades, but has little or no scientific backing that is relevant for the human species. Apparently, the hypothesis is false and should be buried.“

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Nationwide Study in Sweden Finds No Benefit

(2011) Researchers at Linköping University looked at statin usage across all but one municipalities of Sweden and found that statins had not provided any benefit despite a large increase in usage. This study is important because it is one of the few studies that have looked retrospectively at if statins actually work in the real world. Double blind placebo controlled clinical trials are considered the gold standard but what is often overlooked is that the results of a clinical trail are a prediction of how the drug will perform in the real world, not a certainty. In a clinical trial the trial participants are carefully selected and the same results do not necessarily materialise in the real world. In this national study of Sweden the researchers found no benefit in the real world.

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Lipid levels in patients hospitalized with coronary artery disease.

(2009) The American Heart Journal published analysis of 136,905 patients admitted to hospital with heart disease in the United States. They found that people with heart disease have lower levels of LDLs (so called “bad” cholesterol) than the general population. In essence, lower LDLs were associated with a greater risk. Not higher LDLs as we are told.

Link to study

Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction.


(2009) Researchers at the Henry Ford Heart and Vascular Institute, Detroit, USA found that lower LDL levels were associated with worse 3-year survival after ST segment elevation myocardial infarction, which is the most severe type of heart attack.

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Lipid Paradox in Acute Myocardial Infarction— The Association With 30-Day In-Hospital Mortality

(2015) Researchers at Kaohsiung Medical University in Taiwan looked at the LDL levels of people admitted to hospital after a heart attack. They found that lower LDL levels were associated with a significantly higher 30 day death rate.

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Lack of an association or an inverse association between low-density- lipoprotein cholesterol and mortality in the elderly: a systematic review.

(2016) This is the first systematic review of cohort studies where low-density lipoprotein cholesterol (LDL-C) has been analysed as a risk factor for all-cause and/or cardiovascular mortality in elderly people. The conclusion:

“High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.“

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LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature.

(2018) Almost the same researchers as the study above conducted another review. The researchers concluded that the cholesterol hypothesis is unable to satisfy any of the Bradford Hill criteria for causality and support for the cholesterol hypothesis is often based on misleading statistics, exclusion of unsuccessful trials and ignoring numerous contradictory observations.

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The statin-low cholesterol-cancer conundrum.

(2011) Three giants in the study of cholesterol and statins, Dr. Uffe Ravnskov, Dr. Kilmer McCully and Professor Paul J. Rosch published a paper in 2011 examining, as the title suggests, the link between low cholesterol, statins, and cancer. There is an established connection between low cholesterol and cancer however, whether or not statins cause cancer is more difficult to determine when all the data is considered. The authors take a sophisticated look at this issue.

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Statins and All-Cause Mortality in High-Risk Primary Prevention

(2010) Professor Kausik Ray and colleagues completed a meta-analysis of 11 randomized controlled statin clinical trials Involving 65 229 participants. This paper is significant because it was the first study to more accurately separate out the data for primary and secondary prevention. They found that the use of statins in primary prevention does not extend life expectancy. Interestingly, Professor Ray has since continued to be a strong supporter for the use of statins and cholesterol lowering.

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Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms.

(2015) Professor Okuyama and Professor Hamazaki from Japan, along with Dr. Peter Langsjoen, and others published an important paper detailing the ways that statins actually cause heart disease. They discuss the studies showing statins cause an increase in the amount of calcified plaque in the arteries (these studies should be listed as separate entries in this blog post). Along with the other ways that statins damage the heart through CoQ10, vitamin K2 and selenium depletion.

Link to the study

Towards a Paradigm Shift in Cholesterol Treatment

(2015) Professors Okuyama and Hamazaki publish a supplemental of more than 100 pages discussing cholesterol issues. The focus is more on Japan however the data discussed is relevant to every country. They discuss the huge amount of data confirming a link between low cholesterol and a shorter life expectancy, and low cholesterol and an increased incidence of various cancers and other serious diseases.

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Cholesterol “the Hallmark of Animal Life”

We know that cholesterol is essential for life. Cholesterol plays an important role in the immune system and is critically important for the structural integrity of all the 50 trillion plus cells the body is made up of.

Cholesterol is also the raw material needed for all of the sex hormones, bile acids for digestion, and vitamin D. And certain parts of the body such as the brain, the nervous system and the eyes need a lot more cholesterol than other parts of the body. For example, 25% of the body’s cholesterol is found in the brain.

Knowing this, it should not be a great surprise to find that eggs, the symbol of life itself, are high in cholesterol. The egg is the symbol often used to represent the primordial source, and was apparently frequently used by a wide range of early cultures when depicting the origins of the universe. Since cholesterol is an important life giving nutrient, we would expect it to be present in abundance during the early stages of life.

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Now, the presence of cholesterol has been used to identify the oldest animal on record. Researchers from Australian national university examined an unusual oval shaped fossil that was preserved in sandstone cliffs in the White Sea region of Russia. The fossil is from an animal that roamed the earth 558 million years ago.

Scientists had previously debated the nature of the fossil. They debated if it was an animal or something else. But the presence of a significant amount of cholesterol enabled it to be unequivocally identified as an animal. The cholesterol molecules they found are in abundance in almost all of today’s animals but have low abundance is other life forms such as bacteria.

Professor Jochen Brocks said “these creatures in fact produce cholesterol, which is the hallmark of animals and tells us in fact that this creature is our earliest ancestor”

Ironic isn’t it that the last few decades have seen a global war on cholesterol..

As a reminder, here are the cholesterol poster and LDL poster I created some time ago. Feel free to print and share.

Cholesterol Poster

Click on the image itself to print / download.

LDL Poster

Click on the image itself to print / download.

LDL ‘cholesterol’ Does Not Cause Cardiovascular Disease - Another New Study.

Two new published studies from Statin Nation interviewees this week should push the cholesterol hypothesis a step back into the history books. Seventeen authors including: Uffe Ravnskov, Paul J Rosch, Sherif Sultan, Tomohito Hamazaki, Peter H Langsjoen, Kilmer S McCully, and Harumi Okuyama, published an article summarising the research showing that LDLs (so called ‘bad cholesterol’) do not cause heart disease. The paper highlights the following points:

  • The cholesterol hypothesis is based on misleading statistics and ignoring contradictory observations.

  • Only around 15% of clinical trials that found a negative result for cholesterol-lowering are cited in other reports.

  • There is no association between total cholesterol levels and the degree of arterial damage - in general, and also with regard to statin clinical trials.

  • In the Framingham Heart Study. “For each 1 mg/dl drop in TC [total cholesterol] per year, there was an eleven percent increase in coronary and total mortality”.

  • The LDL level of patients who have had a heart attack is lower than normal.

  • Elderly people with higher LDL live the longest.

  • Cardiovascular mortality has not decreased as a result of widespread statin treatment. Here is a quote from the paper that refers to this point:

“In a Swedish study including 289 of the 290 municipalities, no association was found between statin use and the change in mortality from acute myocardial infarction (AMI). Also, the American National Health and Nutrition Examination Survey found that during the period 1999-2006 the number of AMI and strokes increased from 3.4 to 3.7%, and from 2.0 to 2.9%, respectively. During the same period mean LDL-C level decreased from 126.1 to 114.8 mg/dL, and the self-reported use of lipid-lowering drugs increased from 8 to 13.4%. Furthermore, statin utilisation in 12 European countries between 2000 and 2012 was not associated with reduced CHD mortality or its rate of change over the years.”

In the second paper, Uffe Ravnskov writes about familial hypercholesterolemia (FH) - a genetic condition that prevents the body from removing cholesterol. People with FH have very high cholesterol levels. FH has often been used as a part of the explanation for the use of statins. However, there is not sufficient data to say that statins benefit people with FH. This is still unknown. However, for some time Uffe Ravnskov has argued that coagulation factors should be considered as a priority - which is the subject of the paper.

One of the videos from the Statin Nation Extras Package discusses this also:

Unfortunately, just this website and the Irish Times seem to have reported on the first study and only this website has reported on the second study. Therefore please share this post with everyone and anyone you can get to listen!

Update (18/09/18): The Sun, Express, and Metro newspapers have now reported on the first study, albeit with various factual errors.

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British Medical Journal Says Statins Provide No Benefit for Healthy Elderly

A new study published today in the British Medical Journal has found statins do not provide any benefit for elderly people, unless they have type 2 diabetes. In order to understand the significance of this study it is useful to first discuss some background and some key important concepts.

Background

Although clinical trials are considered the gold standard in terms of evidence, in reality these trials provide a potential predicted benefit rather than a guarantee of benefit.

Clinical trials and the way they are reported are fraught with issues. Most of these issues relate to the commercial interests. The pharmaceutical company sponsoring the trial believes it owns the data and therefore decides what is published, what is not published, and how and when it is published.

The data can easily be manipulated. The scope or design of the trial can be determined in such a way that might be favorable to the drug being tested. Data about adverse effects can be excluded from the final analysis or not even collected in the first place. The data is also sometimes not made available to other researchers who want to verify the findings. In addition, the results of the trial can be exaggerated in favor of the drug during the writing of the report, by using relative percentages and other misleading calculations.

All of this means it is important to look at post marketing surveillance data and other studies that assess how the medication is actually performing the the real world.

Most of this kind of data for stains has so far failed to show any benefit associated with their widespread use.

For example, researchers collected data from all but one of the municipalities in Sweden and they found that statins had not provided any benefit despite a huge increase in usage.

In 2012 the British Heart Foundation published a report detailing a wide range of heart disease statistics. One of the highlights of this report was the decline in the heart disease death rate that was seen in the UK between 2002 and 2010. This decline was attributable to a reduction in the number of people who smoke and improved emergency treatments within hospitals - statins were not listed in the report since they played no measurable contribution to the decline in heart disease deaths. But much of the mainstream media falsely claimed that statins were responsible for the decline - none of the journalists bothered to check.

The New Study

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Now a new study has found no benefit associated with the use of statins in healthy elderly people. But the study did find a benefit for elderly people with type 2 diabetes (more about that later).

This was a large study conducted in Spain and published in the British Medical Journal today. Using data from the Catalan primary care system database (SIDIAP), the researchers identified 46,864 people aged 75 years or more with no history of cardiovascular disease between 2006 and 2015.

Through my contacts I obtained the press release from the British Medical Journal and read the study report prior to official publication.

The press release from the British Medical Journal reads: “New study does not support widespread use of statins in healthy older people to prevent heart disease and stroke”

One thing that makes this study significant is that according to the current clinical guidelines for cardiovascular disease (CVD) prevention, most of the people in this study would be suitable candidates for statin treatment. This should lead to an urgent reassessment of the guidelines, which many doctors already suspect are designed to put more people on statins unnecessarily.

In the study, any benefit was limited to just those people with type 2 diabetes aged between 75 and 84. After age 84, the benefit also disappeared in the type 2 diabetes population.

An important question remains concerning why the diabetic patients benefited when the other patients did not?

It is widely acknowledged that statins cause type 2 diabetes (T2DM). It would be expected that any statin induced diabetes would play out as an increase in heart disease in older age. Since people with diabetes are up to five times more likely to have heart disease.

If the statin benefits were great enough to compensate for this somehow and still produce a benefit, then surely this benefit would also have been seen in the non-diabetic population? I contacted the lead author of the study to ask this specific question and I received the following reply:

"We agree that there exists evidence about the increased risk of T2DM associated with statins, however, we did not observe such increment in our study in people older than 74 years. We have pointed out possible explanations for these results:
The increased risk for T2DM associated with statins is higher in persons with intensive statin regimens, and 85% of statin regimens in our study published in the BMJ were of low to medium potency,
The mean follow-up of the study participants was 7.7 years (which is also the approximate mean duration of statin consumption), thus the possibility that longer duration of statin use might have shown an increased incidence of diabetes cannot be ruled out.
We also speculated with the possibility that the effect of statins on the glucose metabolism may be age-dependent, but this question remains to be elucidated in future independent studies.
We considered that the main explanation to justify the restriction of the benefit from statin therapy to individuals with T2DM was the association of statin effectiveness with the CVD risk of the individuals. In our study, participants with T2DM had a higher prevalence of other cardiovascular risk factors (hypertension, hypercholesterolemia, tobacco use, obesity) than the general population of the same age, and the incidence of cardiovascular disease in those with diabetes was more than 50% higher than in those without diabetes.
Following current guidelines, most of the population older than 74 years would be suitable candidates for statin treatment because the incidence of CVD in this population (i.e. risk) is well above the risk threshold of 10%, but this increased risk is mainly due to age. We think we need specific risk prediction tools for these older people.
Our results do not support these recommendations in the old and very old persons without diabetes, and they raise an important question: whether the current risk threshold for statin indication (10% risk of atherosclerotic CVD at 10 years) is appropriate in this population." Dr. Rafel Ramos, Department of Medical Sciences, School of Medicine, University of Girona, Spain.

I have included Dr. Ramos's reply in its entirety. In my view it is a fairly balanced explanation, which is extremely refreshing. All too often we see reports intent on portraying statins as a wonder drug. 

In the report itself the authors do also state that the possibility that a longer duration of statin use might have shown an increased incidence of cancer, or haemorrhagic stroke.

The study has important implications for millions of healthy elderly people who are taking statins.

Finally, it is worth mentioning that any benefit found in this study for elderly diabetic people needs to be considered alongside the huge amount of data showing that higher cholesterol is generally better, particularly in the elderly:

And also, don't let statins break your heart!

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References:

Nilsson, S et al. No connection between the level of exposition to statins in the population and the incidence/ mortality of acute myocardial infarction: An ecological study based on Sweden’s municipalities. Journal of Negative Results in BioMedicine 2011, 10:6 https://jnrbm.biomedcentral.com/articles/10.1186/1477-5751-10-6

British Heart Foundation report: Coronary Heart Disease Statistics 2012. Available from https://www.bhf.org.uk/publications/statistics/coronary-heart-disease-statistics-2012

Link to the new study: http://www.bmj.com/content/362/bmj.k3359

Revolutionary Electromedical Cancer Treatment Approved by EU

The European Union has just approved a revolutionary cancer treatment that was featured in my documentary film Body Electric.

The TheraBionic device uses radio frequency electromagnetic fields to treat advanced hepatocellular carcinoma (liver disease). The fields block the growth of tumor cells, while not affecting the growth of normal cells. The approval of the device by the EU represents a huge step forward in the acceptance of alternative treatments based on the understanding of bioelectricity.

Professor Pasche and colleagues (featured in Body Electric) had previously found that different types of tumor respond to specific frequencies and the treatment is adjusted accordingly. The premise of the Body Electric film is that the future of medicine is electrocueticals based on an understanding of bioelectricity, with less emphasis on pharmaceuticals.

This development was also reported in The Cancer Letter

A Move Towards Totalitarian Medicine?

People often ask me, if statins are so bad why do so many doctors prescribe them? This is a good question - it is perfectly understandable that people feel conflicted by the differing points of view.

Doctors worldwide prescribe statins to tens of millions of people who do not need them. These people will not receive any benefit from the medication and have a significant possibility of life altering adverse effects. Part of the reason for this catastrophic situation is related to the medical system in general. In particular: the commercial interests, the hierarchical nature of medicine, the Flexner report (discussed in Body Electric), medical education that is not only influenced by commercial interests but also professors representing the old guard unwilling to accept new evidence, unprofessional and lazy journalism, commercially driven media organizations, few unbiased alternative information sources, and the implementation of commercially driven clinical guidelines. Now, a new factor could be emerging - a new way to exert peer pressure on doctors.

Researchers at the University of Pennsylvania have found a way of nudging doctors to prescribe more statin medications to people who don’t need them. Well, actually two new ways, but both using a similar method. They used an online patient dashboard with 'nudges' to doctors. One nudge provided physicians with information on their performance relative to other physicians in terms of prescribing, and the other a simple prompt to physicians to make a decision on prescribing a statin.

During the study, the dashboard nudge that showed the physician information on their performance relative to other physicians, led to more than 3 times as many statin prescriptions. When compared to normal care.

The medical profession sometimes believes it is immune to the effects of persuasion and suggestion. For example, a survey conducted on medical students found that 86% thought it was improper for a politician to receive a gift, but only 46% thought it was improper for themselves to receive a gift of a similar value from a pharmaceutical company. Indicating that the medical students believed they would be less influenced by a gift than politicians are.

But the fact that simple onscreen nudges can lead to 3 times as many prescriptions, indicates that doctors are in fact only human. And these aspects do influence prescribing outside of the evidence base.

This should be a concern for all kinds of reasons. Not least because according to a survey completed in America, 94% of doctors have some kind of link with the pharmaceutical industry.

The idea of nudging the prescription habits of doctors is in my view a deterioration towards achieving control by the drugs companies over what doctors do. Commercially influenced clinical guidelines already do a good job of that, and now nudging doctors using peer pressure can help to exert control over those doctors brave enough to do what they think is best for the individual patient despite the guidelines.

Below is a video excerpt from the Statin Nation extras. Professor Peter C. Gøtzsche talks about clinical guidelines and the fact that these can sometimes inappropriately restrict doctors.

 

The study discussed above is published in JAMA

Effect of an Automated Patient Dashboard Using Active Choice and Peer Comparison Performance Feedback to Physicians on Statin PrescribingThe PRESCRIBE Cluster Randomized Clinical Trial

Other studies referred to:

Campbell, EG et al. “A National Survey of Physician-Industry Relationships” New England Journal of Medicine 2007; 356:1742-1750

Wazana, A “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” Journal of the American Medical Association 2000; 283:373-380

Other links:

https://www.sciencedaily.com/releases/2018/07/180728084128.htm

https://www.europeanpharmaceuticalreview.com/news/77830/nudging-triples-prescription-statins/

'Good' Cholesterol (HDLs) Found to be Bad in New Study

We all know the official line - the higher your cholesterol level the greater your risk for heart disease. And a high level of LDLs or a low level of HDLs is bad.

 Image by TLECOATL ZYANYA

Image by TLECOATL ZYANYA

In fact, every aspect of this hypothesis has been repeatedly destroyed, but the vast majority of the medical community continue to ignore the facts, as astonishing as this is.

We have studies going back more than 40 years showing a strong link between higher cholesterol and a longer life. Other studies have shown a strong link between higher cholesterol levels and reduced incidence of cancer and infections (see this video clip).  

A dietary trial published in the British Medical Journal in 2016 found that for each 30 mg/dL (0.78 mmol/L) reduction in cholesterol there was a 22% greater risk of death (see previous post here).

We also know that people who have a heart attack do not have high cholesterol - they have the same average total cholesterol levels as other people of a similar age (see this previous post here).

And we know that cholesterol-lowering at the population level does not reduce the risk of heart disease (see Statin Nation).

The LDL level (so called bad cholesterol) is also actually lower in people with heart disease, not higher - according to a large study published in the American Heart Journal.

Higher levels of so called ‘bad’ cholesterol also predict better athletic performance (see here).

Drugs that increased HDLs (so called good cholesterol) have increased the number of deaths. The drug Torcetrapib reduced "bad" LDLs by 25% and increased "good" HDLs by 72%, and at the same time increased the number of deaths due to cardiovascular causes by 40% and doubled the number of deaths from all causes (see Statin Nation book and this blog post).

Now, a new study has again challenged the idea that HDLs are good. The new study has been published in the American Heart Association journal Arteriosclerosis, Thrombosis, and Vascular Biology. The researchers found an association between higher HDL levels and an increase in carotid plaque in women.

Medscape recently reported comments from Robert Rosenson, MD, Mount Sinai Icahn School of Medicine, New York City, who has chaired four international working groups on the biology HDLs.:

"HDL can be a good, bad, or neutral particle," he said.

And that’s not all. A few days ago Professor Sheriff Sultan (featured in Statin Nation II) informed me about a study recently completed in China at Sichuan University and funded by a Sichuan Province-Supporting Technology Project. The study compared blood cholesterol and blood glucose in patients with coronary artery atherosclerosis and healthy individuals.

The researchers found that the cholesterol levels did not correlate significantly with artery atherosclerosis but blood glucose levels did.

The researchers stated: “Hyperlipidemia is not an important cause of coronary atherosclerosis”.

And yet again there is a lack of reporting from the media about these studies - because most journalists are lazy and they only write about cholesterol and statins when a press release is issued from a drugs company that they can cut and paste into their newspaper or website.

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New Study Finds Statin Use Associated With Another Type of Muscle Damage.

It is already well-known that statins damage muscles. This is the most common of all the statin adverse effects, and somewhat ironically includes damage to the heart muscle.

Now a new study has found another link between statins and muscle damage. This time Idiopathic inflammatory myositis (IIM) - a varied group of autoimmune related muscle disorders that are characterised by chronic inflammation that results in muscle weakness. These conditions can cause gastrointestinal, cardiac and pulmonary dysfunction. According to the British Society for Rheumatology these muscle conditions are a significant problem for morbidity and mortality.

Lead author Gillian E. Caught from Adelaide Medical School, University of Adelaide, South Australia, told theheart.org | Medscape Cardiology:

Neuropathology_case_XII_02.jpg

"They are severe, debilitating conditions that can result in permanent disability and death, and unfortunately, do not go away when the statin is discontinued because the statin has triggered an autoimmune response. That is why these patients need to be treated aggressively with steroids to help try to get the condition under control."

Dr Caught also said that the general musculoskeletal adverse effects associated with statin use are well known and are estimated to affect between 7% and 29% of all statin users.

The new study is published in the Journal of the American Medical Association (JAMA).

It is a population-based case-control study using the South Australian Myositis Database and the North West Adelaide Health Study, using data from confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older.

Patients with Idiopathic inflammatory myositis were 79% more likely to be taking statins than the control group.

As more studies emerge confirming what patients have been saying for decades about statin adverse effects, the real risk / benefit ratio associated with statin use is becoming more clear. Increasing, data is showing that statins cause far more harm than we have been led to believe.

Media Silence and Misinformation

As far as I can see this important finding has not been reported anywhere in the mainstream media. Instead, articles like this one published in the Irish Independent continue to suggest that statins are saving lives.

A Huge Problem

Recently, the CDC found that 50% of men and 38% of women aged 60 years and older in America were taking a medication to lower cholesterol.

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Higher Cholesterol Builds Muscle

Back in 2011 during the making of Statin Nation, I communicated briefly with Dr. Steve Riechman at Texas A&M University. Dr Riechman had completed some studies that showed people with higher cholesterol levels tend to gain more muscle mass. At the time, I didn’t realise that Dr Riechman had actually given a presentation to explain these studies. I recently found this and I think its worth sharing.

Dr Riechman was initially looking at what genetic influences determine muscle gain but he discovered that the genetic effects would get lost in what people ate - food seemed to be more important than genetics. He fairly quickly discovered that cholesterol helps to build muscle. During his studies the more cholesterol the person ate the more muscle they gained with resistance training.

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The diagram above is taken from Dr Riechman's presentation. It shows the amount of cholesterol consumed against the amount of learn muscle mass gained. It is worth noting that the level of cholesterol consumption that was for decades recommended by the American Heart Association is associated with the least lean muscle gain.

Dr Riechman then compared this data on dietary cholesterol levels with total blood cholesterol levels. The yellow bars in the diagram below represent ‘healthy’ blood cholesterol levels as recommended. Low blood cholesterol levels are supposed to be ideal but low cholesterol levels resulted in an actual loss of lean muscle mass - even though the trial participants were resistance training.

Screen Shot 2018-07-18 at 19.53.32.png

Furthermore, it was the so called ‘bad cholesterol’ (LDLs) that predicted the muscle gain. The so called ‘good cholesterol' (HDLs) did not make any difference to muscle gain. Those who had higher levels of ‘bad cholesterol’ had greater muscle gain than those with lower levels of ‘bad cholesterol’.

Dr Riechman battled for 2 years with medical journals to get this research published.

In his presentation, included below, Dr Riechman then goes on to explain more about the actual mechanisms involved and also discusses some of the other important uses of cholesterol within the body.

Another important point he makes is that there is an incredible need tor cholesterol during periods of recovery and the body can’t get enough of it at these times.

Six Things Better than Taking a Statin

Here is a list of six things to consider doing instead of taking a statin. Each of these individual interventions ha been shown to provide greater benefits than statin medications. Just image what can be achieved if all of these are combined.

Exercise

We all know that exercise strengthens the cardiovascular system and protects us from heart disease. In fact, general fitness is strongly associated with protection from dying of all causes. People with the lowest capacity for exercise have 4.5 times the risk of dying when compared with people who have the greatest capacity for exercise.


Exercise does not have to take place in a gym. Any kind of physical movement that increases the heart rate is likely to be beneficial. Health authorities recommend at least thirty minutes of movement or exercise on as many days during the week as possible.


Exercise is also very beneficial for people with diabetes and for the prevention of diabetes, because exercise increases insulin sensitivity (insulin resistance is the hallmark of diabetes). Exercise also helps to reduce visceral fat. This should be a source of encouragement for people who struggle to lose weight when exercising. The harmful visceral fat could still be reducing even if the number on the scale does not change very much. Waist circumference is a better indicator than a bathroom scale.

Drink more water

In 2002, researchers published a study that investigated the amount of water consumed each day and the number of heart disease deaths.

The study included around 20,000 men and women between the ages of 38 and 100, who were followed for 6 years. The researchers found a strong correlation between increased water consumption and a reduction in heart disease deaths. On average, the people drinking five or more glasses of water per day had about half the risk of dying of heart disease compared with people who drank two glasses or less per day.  The association remained the same even after eliminating a wide range of other factors such as age, smoking status, high blood pressure, body mass index, education level, and estrogen replacement therapy in menopausal women.

Coq10 supplement

Some of the most dramatic results were found in a Swedish study published in 2013 that included 440 people aged 70-88 who were split into two groups; one group received a placebo, while the other group received supplemental selenium and CoQ10.  After five years, those in the placebo group had a cardiovascular death rate of 12.6 percent, while those in the group who received selenium and CoQ10 had a cardiovascular death rate of 5.9 percent. This dramatic reduction in cardiovascular mortality is considerably greater than any reduction ever seen in any statin clinical trial.

Vitamin C supplement

Vitamin C is used to make collagen - which lines all of the blood vessels.
In 2004, The American Journal of Clinical Nutrition published an analysis of nine studies that included information on intakes of vitamin E, carotenoids, and vitamin C. The most significant finding was that people who took 700 mg or more of supplemental vitamin C had significantly fewer heart attacks.

Relaxation and meditation

A study published in the journal Circulation in 2012 investigated the use of transcendental meditation for people with heart disease. Participants were split into two groups; one group completed twenty minutes of meditation twice every day, while the other, dubbed the “health education group”, was instructed to spend the same amount of time doing other health-promoting activities such as preparing healthy meals, exercising, or nonspecific relaxation.
After five years of follow-up, 31 percent of the people in the health education group had either had a heart attack or stroke, or died, compared with 20 percent of those in the meditation group, representing an absolute risk reduction of 11 percent associated with meditation, above the benefits associated with more common health-promoting activities.

Not taking a statin

In the studies that have been most supportive of statins, the reduction in heart attack deaths has typically been between 1% and 3%. However, the side effects of the medication are experienced by around 20% of people. And these side effects include an increase in the amount of calcified plaque. Overall, almost everyone will be better off not taking a statin, than taking a statin.


From: STATIN NATION:The Ill-Founded War on Cholesterol, What Really Causes Heart Disease, and the Truth About the Most Overprescribed Drugs in the World


References:

Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.
Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE. Water, other uids, and fatal coronary heart dis- ease: the Adventist Health Study. Am J Epidemiol. 2002;155(9):827–833
Knekt P, Ritz J, Pereira MA, et al. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80(6):1508–1520.
Alehagen U, Johansson P, Bj rnstedt M, Rosén A, Dahlstr m U. Cardiovascular mortality and N-terminal proBNP reduced after combined selenium and CoQ10 supplementation: a 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Int J Cardiol. 2013;167(5):1860–1866
Schneider RH, Grim CE, Rainforth MV, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health educa- tion in blacks. Circ Cardiovasc Qual Outcomes. 2012;5(6):750–758. doi:10.1161/CIRCOUTCOMES.112.967406.

How Much L-Arginine?

One of the biggest problems with statins is that they are prescribed to lower a perceived risk factor without full consideration to the other effects they have. But the prescription of natural nutritional supplements can also fall into this same trap.

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There are a number of nutritional supplements that have been shown to be much more effective than statins. But I think it is important to also warn people about the potential dangers of some of them.

L-arginine is a widely available nutritional supplement for lowering blood pressure and is often recommended for the prevention of cardiovascular disease. L-arginine is an amino acid that converts into nitric oxide. Nitric oxide is an extremely important substance for dilating the blood vessels and is therefore critical for adequate circulation. Through this mechanism l-arginine does lower blood pressure and may also help with erectile dysfunction.

However, when I interviewed Professor Sherif Sultan, one of the world’s leading vascular and endovascular surgeons, for Statin Nation II, he explained that L-arginine supplementation has been shown to cause a number of adverse effects. L-arginine can cause some types of cancer to spread. Some forms of irregular heartbeat can also be made worse by L-arginine, and L-arginine can actually cause blood pressure to become dangerously low for some people.

A study published in the Journal of the American Medical Association in 2006 looked at the effect of giving L-arginine to patients after they had suffered a heart attack. It found that L-arginine, surprisingly, did not improve vascular stiffness measurements. In fact, six patients in the L-arginine group died during the six-month trial compared with no deaths in the placebo group. The researchers understandably concluded that “L-Arginine should not be recommended following acute myocardial infarction".

The results of this study are in conflict with other studies done on l-arginine by others such as Nobel Prize winning researcher Louis Ignarro. Published in 2004. However, those studies were done on mice instead of humans and they also included other nutrients such as vitamin C that we would expect to have a beneficial effect - the benefit could be from the vitamin C rather than l-arginine.

To add more confusion, a study published in the journal circulation in 1996 found that l-arginine supplementation had beneficial effects for patients with severe heart failure.

In the 2006 study that found l-arginine to be harmful the study participants were given 3grams of l-arganine 3 times a day for 6 months. And in the 1996 study that found a benefit for heart failure patients, a larger amount of l-arginine was used (5.6-12.6grams per day), but just for 6 weeks. So, all of this makes it very difficult to determine an appropriate dose. Obviously it depends very much on the individual person and any existing health conditions. Caution suggests that the dose should be kept below 8grams per day.

Anyone who feels l-arginine is benefiting them personally should also try to investigate if this benefit cannot be attributed to other nutrients they are taking, We cannot yet be sure about the overall effects of l-arginine.

References:

-Long-term combined beneficial effects of physical training and metabolic treatment on atherosclerosis in hypercholesterolemic mice. Proc Natl Acad Sci U S A. 2004 Jun 8; 101(23): 8797–8802. Published online 2004 May 28. doi:  10.1073/pnas.0402734101
PMCID: PMC423275

-Rector TS1, Bank AJ, Mullen KA, Tschumperlin LK, Sih R, Pillai K, Kubo SH. Randomized, double-blind, placebo-controlled study of supplemental oral L-arginine in patients with heart failure. Circulation. 1996 Jun 15;93(12):2135-41.

-Schulman SP, Becker LC, Kass DA, et al. L-Arginine therapy in acute myocardial infarction. The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) randomized clinical trial. JAMA. 2006;295(1):58–64. doi:10.1001/jama.295.1.58

The Real Causes of Heart Disease - [and Statins don't help]

My latest article about the real causes of heart disease has just been published in Positive Health.

Heart disease is the leading cause of death worldwide. For decades our health authorities and the majority of the medical profession have told us that dietary saturated fat and cholesterol are primary causes of heart disease. This has been the main justification for an estimated thirty-five to forty million people in the United States, seven to eight million people in England, and millions more people worldwide being prescribed cholesterol-lowering statins. However, in this article I will argue that the way we have been looking at the causes of heart disease is fundamentally flawed and taking statins offers very little to no protection.

http://www.positivehealth.com/article/heart/the-real-causes-of-heart-disease-and-statins-don-t-help

The Real Issues Concerning Salt and Cardiovascular Disease

Various health authorities tell us that consuming too much salt is bad for the heart. More specifically, experts are concerned about the intake of sodium compared with potassium. The World Health Organization advises adults to consume less than 5 grams of salt, less than 2 grams of sodium, and more than 3.5 grams of potassium each day.

The concern is largely based on observations that a high sodium intake, or a low potassium intake relative to sodium, can increase blood pressure. The American Heart Association has even stricter guidance and recommends an intake of no more than 1.5 grams of sodium per day. This guidance is based on studies that have suggested that sodium intake below this level is associated with lower blood pressure. The mechanisms by which sodium intake influences blood pressure are not yet fully understood, but they are thought to be related primarily to the intimate relationship between sodium and water.

When sodium is absorbed through the gastrointestinal tract, it brings water with it, keeping the body hydrated. The major liquids of the body are sustained because of sodium. Without sodium the liquid component of blood and the liquids that surround the body’s cells would lose their water, leading to dehydration and death.

 Image credit: By © 2011 by Tomasz Sienicki via wikki commons.

Image credit: By © 2011 by Tomasz Sienicki via wikki commons.

The body uses various systems to try to keep the correct balance of sodium and water. Information is sent from the blood vessels and the brain that tells the kidneys to retain sodium or excrete sodium in the urine. Sodium intake also causes changes in thirst as a means of regulating water relative to sodium.

If too much sodium is consumed, sodium’s affinity with water is believed to cause an increase in the liquid volume and an increase in the pressure within the blood vessels. Potassium does not have the same affinity with water. In fact, potassium and sodium are antagonistic to each other; potassium counters the effects of sodium, and vice versa.

The intracellular space (inside the body’s cells) contains a lot more potassium than the extracellular space (the liquid surrounding the body’s cells) and the reverse is true for sodium. Therefore, the body clearly requires an appropriate balance of sodium and potassium, but the current recommendations for sodium intake might not be serving us well.

Studies on salt intake are somewhat problematic. Comparing data between various studies is difficult because two different methods are used for measuring salt intake: measuring urinary sodium excretion and estimating dietary intake. Twenty-four-hour urinary sodium excretion might be the most accurate method, since 90–95 percent of sodium intake is excreted in the urine. However, it is not practical to collect twenty-four-hour’s worth of urine, particularly during an extended study period, so researchers have suggested that fasting morning urine is a reliable substitute. Urinary sodium excretion does not account for sodium loss due to sweat.

Dietary intake is measured with the aid of food diaries and questionnaires. However, there is considerable room for inaccuracies if the study participant does not recall all of the foods they consumed. Further inaccuracies can arise because of differences in the sodium content of common foods and if table salt is not included in the analysis. In addition, portion size needs to be accurately accounted for.

Dietary recommendations for salt intake are largely based on clinical studies that use urinary analysis. But population surveys have used dietary recall for the analysis, and there is no existing method for comparing these two different measurements.

The analysis is made more complicated by differences in how each person consumes sodium. One person might have a higher sodium intake because of consuming processed foods such as ready- made meals, whereas another person might be getting their sodium from a more balanced diet that also includes more fresh fruit and vegetables. Therefore, some diets might be high in sodium but also high in potassium. Some people’s diets could also be high in other cardio-protective nutrients that could be offsetting the otherwise negative impact of the sodium.

Notwithstanding these difficulties in interpreting the data, studies have generally, on balance, shown a connection between lower sodium intake and lower blood pressure, although the reduction in blood pressure associated with lower sodium intake is often quite small. For example, an analysis completed by the Cochrane Hypertension Group found that a modest reduction in sodium intake resulted in an average reduction of 5 mmHg in systolic blood pressure and a reduction of 2.7 mmHg in diastolic blood pressure for people with high blood pressure. People with normal blood pressure had smaller reductions (2.3 mmHg for systolic and 1 mmHg for diastolic). Mathematically, if a 2 mmHg reduction in diastolic blood pressure is applied across a very large population (such as nationwide), this would result in an overall 6 percent reduction in heart disease risk. But how relevant these small reductions in blood pressure are for individual people is debatable.

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Since blood pressure fluctuates as a result of a wide range of different conditions, it is important to look for a connection between lower sodium intake and an actual reduction in cardiovascular problems, rather than looking at changes in blood pressure alone. Such studies have had mixed results; some have confirmed an increased risk of cardiovascular disease in connection with a high sodium intake, while others have not. In fact, overall, researchers have suggested that the relationship between sodium intake and cardiovascular disease follows a J-shaped curve whereby both a low and high sodium intake could involve an increased risk.

Statistically, the lowest cardiovascular risks have been seen with a sodium intake of 3–5 grams per day, with an increased risk associated with both higher levels (above 5 grams per day) and lower levels (below 3 grams per day). This is important because although the data does confirm some kind of connection with sodium intake, the current recommendations are set too low and are associated with an increased risk. As mentioned above, health authorities currently recommend a sodium intake of 1.5–2 grams per day. Overall, this level of intake is associated with an increase in cardiovascular problems.

Health authorities could have become blinded by the blood pressure–lowering effect of a very low-sodium diet, and they could have failed to consider the other effects of such a diet. A very low-sodium diet has been shown to alter levels of some hormones and cytokines that are involved in cell-to-cell communication. A moderate, rather than low, sodium intake has even been shown to improve outcomes for some heart failure patients.

As mentioned, we should also consider potassium intake, not just sodium intake, as there is some evidence that potassium might exhibit a similar relationship. A study that analyzed the data from approximately 39,000 patients in the United States who had already suffered a heart attack found a U-shaped curve. Similar to sodium, both low and high levels of potassium were associated with an increased cardiovascular risk, with the lowest risk associated with moderate potassium levels.

The J-shaped and U-shaped curves for sodium and potassium respectively might be a further indication that the levels relative to each other are what is most important. Indeed, there is some data suggesting that a higher sodium-to-potassium excretion ratio is more strongly associated with increased cardiovascular risk than that of sodium or potassium alone.

Sodium/Potassium Balance after Heart Attack

The importance of the correct balance of sodium and potassium is further illustrated by the observation of heart muscle tissue after a heart attack. In an acute heart attack, tissue damage can be seen in three zones of heart muscle tissue. The core area consists of necrotic tissue and dead cells due to the absence of oxygen. Next to this there is an area of severe injury that is composed of cells that will die if the metabolic derangement cannot be corrected. Last, surrounding this area is a less ischemic zone, where cellular function is impaired but is reversible. In short, there is a gradient of extent of damage and metabolic derangement, with the extent of damage gradually reducing with increasing distance away from the necrotic core.

The damage gradient correlates with the amount of sodium inside the cell. As mentioned, there is a lot more sodium outside the cell (the extracellular space) than inside the cell. Under healthy conditions, there is a powerful mechanism for constantly pumping excess sodium out of the cell, the sodium-potassium pump; however, after a heart attack the membrane of the cell is damaged and additional sodium enters the cell. The excess sodium increases the liquid volume of the cell, causing it to swell, and cellular function and the ability to pump the excess sodium out of the cell is impaired.

The outer area of tissue damage typically corresponds with a 50 percent increase in the amount of sodium in the cell. The intermediate zone corresponds with a 200 percent increase in sodium, and the inner necrotic core has a 300 percent increase in sodium.

At the same time a similar, but reverse, situation is observed with potassium. Normally there is much more potassium inside the cell than outside, but after a heart attack there is a decrease in the potassium content inside the cell that again corresponds with the degree of tissue damage within the three affected zones.

These observations led Dr. Demetrio Sodi Pallares of Mexico City to develop a polarizing solution to help correct the sodium-potassium deregulation after an acute heart attack. The solution was based on earlier work done by Henry Laborit, a French researcher, and consisted of glucose, insulin, and potassium. The insulin helps the glucose and potassium into the cell.

Dr. Pallares had quite dramatic positive results using the polarizing solution in the 1960s, and a number of prominent cardiologists around the world also started administering it. At that time, and in a number of studies completed since, the polarizing solution reduced the number of deaths, the amount of tissue damage, and complications such as arrhythmias after a heart attack.

In fact, the potential benefits of the polarizing solution also extend into other areas of medicine that are beyond the scope of this topic and involve the electrical potential across the cell membrane and the additional use of electromagnetic fields. A more detailed discussion is available in the excellent book Bioelectromagnetic and Subtle Energy Medicine.

Statins Damage Gut Microbiome and Contribute to Antibiotic Resistance

Our digestive tract contains about 2 kg of microbes (the microbiome). These microbes, often referred to as friendly bacteria, help with digestion, the production of vitamin B and vitamin K, and play a major role in the immune system.

A recent study published in Nature has found that statins disturb the gut microbiome - they inhibit the growth of some potentially useful bacteria in the gut and allow other bacteria to flourish and become superbugs resistant to antibiotics.

The study found that a wide range of commonly prescribed medications interfere with the gut microbiome, including simvastatin.

The study confirms what has previously been seen in studies done on mice given statins. These previous studies have found that rosuvastatin, atorvastatin and pravastatin also cause profound alterations in the balance of gut microbes. And this imbalance is similar to what has been seen in diet-related obesity.

 Antibiotic Resistance -the white paper discs contain antibiotics. Most of the bacteria in the dish on the left are sensitive to the antibiotics. The bacteria in the dish on the right are resistant to antibiotics.

Antibiotic Resistance -the white paper discs contain antibiotics. Most of the bacteria in the dish on the left are sensitive to the antibiotics. The bacteria in the dish on the right are resistant to antibiotics.

The human body contains about one third more bacteria cells than human cells, and scientists are still investigating the many ways that these colonies of bacteria live in symbiosis with us. The implications of the changes in the bacteria caused by statins is difficult to predict, however the changes are likely to weaken the host's immune system and ability to produce some specific nutrients. Researchers for the article published in Nature say that statins are also contributing to the global problem of antibiotic resistance.

Antibiotic resistance, according to the World Health Organisation, is one of the most urgent public health problems and “Antibiotic resistance is rising to dangerously high levels in all parts of the world”.

This is an important example of how medicine has become unsustainable. This will likely become yet another serious adverse effect of the widespread use of statins that will simply be ignored in the push to keep hundreds of millions of healthy people as patients for profit.

References:

Maier, L et al. Extensive impact of non-antibiotic drugs on human gut bacteria. Nature doi:10.1038/nature25979. https://www.nature.com/articles/nature25979

Caparros-Martin, JA et al. Statin therapy causes gut dysbiosis in mice through a PXR-dependent mechanism. Microbione 2017; 5: 95. doi: 10.1186/s40168-017-0312-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550934/

Nolan, JA et al. The influence of rosuvastatin on the gastrointestinal microbiota and host gene expression profiles. Am J Physiol Gastrointest Liver Physiol. 2017 May 1;312(5):G488-G497. doi: 10.1152/ajpgi.00149.2016. https://www.ncbi.nlm.nih.gov/pubmed/28209601

Antibiotic Resistence – World Health Organisation. http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/

Daily Mail. http://www.dailymail.co.uk/health/article-5521767/Statins-hayfever-pills-fueling-antibiotic-resistance.html

The Telegraph. https://www.telegraph.co.uk/science/2018/03/19/statins-hayfever-pills-could-driving-antibiotic-resistance-warn/

Image Source: Dr Graham Beards at en.wikipedia [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

Cholesterol and Looking Younger

We already know that cholesterol is the raw material used to make all of the sex hormones within the body, vitamin D, and bile acids. We also know that the brain and nervous system need a lot of cholesterol, and that cholesterol plays an important role in the immune system. Epidemiological studies have shown a strong association between higher cholesterol levels, reduced risk of cancer, reduced risk of infections and a longer life. Cholesterol is also an essential part of the cell membrane and it is this function that has now led to cholesterol being used in a range of anti-aging skin products.

Skinlayers.png

The outermost layer of the skin (medically called the stratum corneum) protects us from dehydration and external dangers. Three major lipids are important for this layer: ceramides, free fatty acids, and cholesterol.

When the level of cholesterol and the other fatty acids within the stratum corneum is reduced it is thought that tiny gaps can appear between the cells and the skin loses moisture quicker, becomes tight, dull and deflated. The skin ages faster and is less able to function as a protective barrier.  This has led to the development of anti-aging cosmetics that contain cholesterol and other fatty acids.

Cosmetics containing cholesterol like the one shown retail for around £100 (US$140)!

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Yet another reason not to worry about cholesterol-rich foods and to think twice before artificially lowering cholesterol with statins or anything else.

This mechanism could also be one of several reasons why a range of skin problems have been reported with statins.

Notes:

  • This entry was prompted by a cosmetics feature in the Daily Mail.
  • Image attribution - Wbensmith [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons
  • The product image is for illustrative purposes only and there is no intention to endorse the product shown. The best way to ensure adequate cholesterol levels is to consume a balanced diet which includes cholesterol containing foods.
  • Also see, Lipids and Skin Barrier Function. Contact Dermatitis. 2008 May;58(5):255-62. doi: 10.1111/j.1600-0536.2008.01320.x.

 

Statins and the Nocebo Effect?

There have been numerous and relentless attempts to play down the extent and severity of statin adverse effects. One of these relates to the nocebo effect.

The nocebo effect suggests that health problems from other causes are blamed on a prescribed medication. The idea is that after taking the tablet the patient reports adverse effects from the medication but these adverse effects have a different cause or may be induced through an expectation of adverse effects due to a widespread belief that the medication can be harmful. In some ways the opposite of the placebo effect.

The nocebo idea, in general, is an interesting concept worthy of debate, however, I believe the way this idea has been applied to statins does not represent what's really happening concerning statin adverse effects.

Claims that statin adverse effects are due to the nocebo effect arose from studies that have found the same number of adverse effects in the statin group as the placebo group. The most recent of these, and probably the most cited, is a study published in the Lancet in May 2017:

Gupta, A, Thompson, D and Whitehouse, A et al. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017 Vol 389 No. 10088 p2473-2481.

This study looked at data from the ASCOT trial. Researchers compared data from the trial period itself with data from a follow-up period where patients were told if they were receiving the statin or a placebo and also given the option to start a statin. During the trial itself about the same number of patients in both the statin group and the placebo group reported muscle aches and pains. But during the follow up period (where patients knew if they were taking a statin or not) considerably more people started to report muscle aches and pains in the statin group than the non-statin group. The researchers and other commentators have suggested that once patients knew they were taking a statin the rate of muscle aches and pains increased in the statin group. A result of the nocebo effect.

noceboeffect-1050x600.png

However, the following points have been overlooked or deliberately ignored:

The researchers suggested that the muscle-related adverse effects were the result of patients now knowing they were taking a statin and can blame the statin for any muscle-related problems (real or imaginary) experienced.

This idea of a nocebo effect relies on the idea that patients have an expectation that statins cause muscle problems. It has even been suggested that the nocebo effect is due to exaggerated reports about statin adverse effects in the media. However, the data that was used for the 2017 Lancet paper was actually collected between 1998 and 2005. Long before statins became a household name and patients could create preconceived ideas about statins.

It is also worth mentioning that:

During the initial trial period there was a statistically significant increase in renal and urinary adverse effects in those people who were given the statin. Something that has never been mentioned before when discussing this study.

During the unblinded phase there was also a statistically significant increase in musculoskeletal and connective tissue disorders and blood and lymphatic system disorders in the people who took a statin.

In the ASCOT trial no one lived any longer as a result of taking the statin.

The idea of the nocebo effect is one reason doctors reject their patients’ reports of adverse effects after starting a statin. Doctors are advised by opinion leaders to watch out for these “false” reports of statin adverse effects and have other explanations ready, such as telling the patient its just due to old age.

Statins Debate

Last November, Professor Sherif Sultan took part in a debate about the use of statins at the VEITH symposium in New York. Professor Sultan argued against the use of statins and he won the debate. Statins were of course a hot topic at the event and after the debate itself the discussions continued. The video below is a (after debate) discussion between Drs Ron Waksman, Ido Weinberg, David Spence and Sherif Sultan.

Other related Video clips and Notes

It is important to note the following, particularly in regard to the comments made by David Spence:

  • The seven countries study referred to by David Spence was the work of Ancel Keys and it is widely now known that Ancel Keys’ work was fraudulent. The seven countries study selectively chose data to fit a preconceived hypothesis. A hypothesis that has repeatedly been shown to be false. (See video clip one about the six nations study and the lipid hypothesis).

VIDEO ONE

  • While some of the comments about the Mediterranean diet are correct, David Spence seems unaware that the Mediterranean diet is different things for different people. For example, he mentions the island of Crete. The island of Crete was used as another example in Statin Nation II, specifically the village of Anogia, where the people eat large amounts of animal fat but have no heart disease, again challenging the lipid hypothesis. (See video clip two).

VIDEO TWO

  • Dr Spence describes how he thinks it is a good idea to scare his patients into complying with statins by showing them images of atherosclerotic plaque - he doesn’t mention that the statin he is prescribing will actually increase the amount of plaque in the arteries. (See video clip three and four).

VIDEO THREE

VIDEO FOUR

  • Dr Spence suggests that “we don’t need much LDL”. Dr Spence should he reminded that LDLs provide the transport mechanism for delivering all the vital nutrients to the cell including:

--coenzyme Q10 (CoQ10) - this is needed for energy production within the cells of the body. In particular, it is needed in the heart muscle cells. CoQ10 is also an antioxidant.

--beta-Carotene (vitamin A) - these are thought to protect against diseases, in particular, protect against cancer and eye disease.

--vitamin E- an antioxidant. It is also involved in the immune system and helps to dilate blood vessels - improving circulation. It also helps prevent coagulation, which is a key feature of heart disease.

Not to mention that people live considerably longer with higher LDL levels and are protected from serious diseases.

This fundamental oversight by Dr Spence displays just how academically corrupted much of the medical profession has become. Someone in his position should know better, especially considering that he claims to be in support of nutritional interventions.