Article Reminds Us of Long Fight Against Misinformation

I was recently looking through a presentation compiled by Dr. Paul J. Rosch, that he gave at a conference in Saudi Arabia in 2010. One of Dr. Rosch's presentation slides displays an image of The Atlantic front cover from September 1989.

This image  reminded me how long the fight against cholesterol misinformation has been going on for. Thomas Moore, MD makes the statement on the front cover:

“Lowering your cholesterol is next to impossible with diet, and often dangerous with drugs – and it won't make you live any longer.”

In my mind, it is astonishing that we knew this at least 23 years ago, and around 5 years before the mass prescription of statins really took off. Yet we still had to go through (and are still going through) many years of unnecessary statin damage to millions of people. Not to mention the other costs to society and the incredible waste of resources that have been directed at cholesterol-lowering.

Here we are in 2013, with mountains of data available to us. Within all of this data, there is still no evidence whatsoever that cholesterol-lowering has benefited anyone's health. We now know that the situation is even worse, in that not only will we not live any longer as a result of cholesterol-lowering, but in fact, we are likely to die sooner with lower cholesterol levels.

Dr Moore's article had a decent amount of exposure. At the time that the article was printed The Atlantic had a circulation of around 450,000. But this of course, was still no match for the immense resources of the pharmaceutical industry. During more recent years these companies have spent hundreds of millions each year promoting the cholesterol myth. 

These sad facts, unfortunately, say quite a lot about the current state of our society. Much of what we believe is simply what powerful corporations would like us to believe. This of course does not only apply to medicine and health, but also climate change, the monetary system, energy production, poverty, food supply, and many other aspects of our daily lives.

References:

To see a video excerpt featuring Dr Rosch in STATIN NATION please click here

To see Dr Rosch's full presentation, "STRESS MORE IMPORTANT THAN LDL", and for more information about how stress can affect the heart click here

Iron Reduction Better than Statins

Dr. Leo Zacharski and colleagues have recently published a study to help explain the effects of statin medications in secondary prevention.

Statin medications do not provide any net benefit in primary prevention (given to people who do not have heart disease). Despite billions of dollars being spent on clinical trials, none of these trials have found any increase in overall life expectancy. However, there is an ongoing debate about the use of statins in secondary prevention.

Some statin trials that have included mostly patients who have already had a heart attack, have shown significant reductions in heart attack risk and increases in life expectancy. On the other hand, there are different viewpoints about the amount of actual life extension that can be achieved, and there is insufficient long term data for us to make a proper assessment. 

Even in secondary prevention, the potential benefits of taking a statin have got nothing to do with cholesterol levels. There is no consistency between the degree of cholesterol lowering and the amount of benefit. Therefore, we have known for some time that the potential benefits of statins in secondary prevention are due to the other effects of statins (commonly referred to as the pleiotropic effects).  

The new study adds to our understanding of these other effects of statins and may provide an alternative treatment that avoids the significant adverse effects of statins.

This new information relates to iron retention. Pathologic cellular iron retention has been implicated in several features of heart disease (systemic oxidative stress and vascular inflammation). Dr. Zacharski had previously found that iron reduction can reduce cardiovascular risk and improve life expectancy in some patients. 

Statin medications are also known to have an effect on cellular iron. The new study compared the effects of statins on iron reduction and cholesterol levels (HDL/LDL ratio). It included patients with advanced peripheral arterial disease.

Improved clinical outcomes were associated with lower iron levels but not with changes in cholesterol levels.

This means that iron reduction may provide a low-cost alternative to statins for reducing inflammation associated with arterial disease.

The iron reduction can be achieved via therapeutic phlebotomy (TP). The procedure is identical to blood donation, except that TP requires a doctor’s prescription. 

Improved iron metabolism could also be achieved by appropriate dietary changes. Of course, the suggestion is not that people should avoid foods containing iron. Rather, each person should have their overall nutritional status assessed and appropriate changes made to reduce the accumulation of excess iron in the cells.

 References:

Zacharski, LR et al. The Statin–Iron Nexus: Anti-Inflammatory Intervention for Arterial Disease Prevention. American Journal of Public Health. Published online ahead of print February 14, 2013.

Zacharski, LR et al. Effect of controlled reduction of body iron stores on clinical outcomes in peripheral arterial disease. American Heart Journal 2011; 162 949-957. 

Cholesterol Derivatives Found to Strengthen the Immune System

New research has confirmed that derivatives of cholesterol play an important role in the immune system and could protect humans from a wide range of viruses such as Ebola, Rift Valley Fever, Nipah, and other deadly pathogens.

Researchers (led by the University of California, Los Angeles) identified cholesterol-25-hydroxylase (CH25H) as a broadly antiviral gene.

CH25H converts cholesterol to a soluble antiviral factor, 25-hydroxycholesterol (25HC). And treating cultured cells with 25HC, inhibited the growth of a wide range of deadly viruses.

25HC suppressed viral growth by blocking membrane fusion between the virus and the cell.

This may be one reason why people with low cholesterol tend to die more frequently from infections.

Back in 1997, researchers in the Netherlands found that life expectancy increases when cholesterol levels are higher. Those with higher cholesterol levels appeared to be better protected from cancer and infections.

Further evidence that higher cholesterol protects against infection was established by Professor Jacobs and Dr. Carlos Iribarren who followed more than 100,000 healthy individuals in the San Francisco area for fifteen years. At the end of the study those who had low cholesterol at the start of the study had a higher rate of infectious disease.

References:

Liu, Su-Yang et al. Interferon-Inducible Cholesterol-25-Hydroxylase Broadly Inhibits Viral Entry by Production of 25-Hydroxycholesterol. Immunity 2013; 38: 92–105.

McDonald, JG and Russell, DW. Editorial: 25-Hydroxycholesterol: a new life in immunology. Journal of Leukocyte Biology vol. 88 no. 6 1071-1072.

Weverling-Rijnsburger, AW et al. Total Cholesterol and Risk of Mortality in the Oldest Old. Lancet 1997; 350:1119-1123

Iribarren, C et al. Cohort Study of Serum Total Cholesterol and In-Hospital Incidence of Infectious Diseases. Epidemiology and Infection 1998;121:335-347

More Evidence that Cholesterol is Vital for the Brain and Immunity

Two recent studies have confirmed the vital importance of cholesterol, in particular, for brain function and the strength of the immune system. 

Scientists at Karolinska Institute in Stockholm, Sweden and Swansea University’s College of Medicine have identified two steroid-type molecules that play an important role in the survival and production of nerve cells in the brain.

These two molecules are cholic acid (a bile acid ) and 24S,25-Epoxycholesterol (a derivative of cholesterol)

24S,25-Epoxycholesterol can be used to turn stem cells into midbrain dopamine-producing neurons, and may help combat Parkinson’s disease.

“...24S,25-Epoxycholesterol, influences the generation of new dopamine-producing nerve cells, which are important in controlling movement.” said Professor William J Griffiths.

"What we have shown now is that cholesterol has several functions, and that it is involved in extremely important decisions for neurons. Derivatives of cholesterol control the production of new neurons in the developing brain. When such a decision has been taken, cholesterol aids in the construction of these new cells, and in their survival. Thus cholesterol is extremely important for the body, and in particular for the development and function of the brain." Ernest Arenas, Professor of Stem Cell Neurobiology at the Department of Medical Biochemistry and Biophysics at Karolinska Institutet.

It is important to note that 24S,25-Epoxycholesterol is produced by the mevalonate biochemical pathway – the pathway that is blocked by cholesterol-lowering statins.

The research was published in the journal Nature Chemical Biology.

The second study was completed by a team of researchers at the University of Freiburg, Germany. Prof. Wolfgang Schamel and colleagues investigated the 'memory' of the immune system. 

When the immune system is first exposed to a new pathogen, it develops the ability to be more sensitive to it when it enters the body the next time. This 'memory' of the immune system is provided by a clustering of T cell receptors. The new study, published in the journals Immunity and Journal of Biological Chemistry, has demonstrated that cholesterol plays a key part in this process.

We already know that one of the most common adverse effects of cholesterol-lowering statins is cognitive decline, and there is a strong correlation between low cholesterol levels and increased infections. 

For more information about the importance of cholesterol, please see the excerpt from Statin Nation below:

References:

Brain endogenous liver X receptor ligands selectively promote midbrain neurogenesis. Nature Chemical Biology 9, 126–133 (2013)  Published online 23 December 2012

Fat Influences Decisions Taken by Brain Cells for Production and Survival. Science Daily December 23, 2012

Swansea University: Latest Research 

Cholesterol Boosts the Memory of the Immune System. Science Daily December 21, 2012  

Cholesterol and Sphingomyelin Drive Ligand-independent T-cell Antigen Receptor Nanoclustering.   The Journal of Biological Chemistry, 287, 42664-42674.

Daily Mail Sepsis (More Misinformation)

A national newspaper here in the UK (the Daily Mail) recently reported “How a 40p statin can stop deadly form of blood poisoning”

OK, here we go again. It’s a great pity that much of the mainstream media no longer consider the implications of what they publish.

This article relates to a recent study published in the journal Critical Care, which investigated the use of a statin in people with sepsis (which is a harmful or damaging response to infection).

It was a small study of 100 people with sepsis. 49 were given a statin and 51 were given a placebo.

I’m not criticising the study itself. From a certain point of view, it might make sense to try the use of statins in cases of sepsis. Statins are known to have anti-inflammatory affects and inflammation, of course, is a key feature of sepsis. However, the anti-inflammatory effect may weaken the body’s immune system overall.

Another important point is statins, of course, lower cholesterol, and low cholesterol levels have been consistently shown to increase the risk for infection.

Therefore, as with any medication, the benefits and risks have to be balanced.

Using some criteria, the use of the statin did reduce the severity of sepsis, however, there were the same number of deaths in both the statin and placebo group. So there was no evidence that the statin actually provided any extension of life. In addition, after one year, there was no difference in hospital readmission between the statin and placebo group. It is also worth mentioning that the researchers measured the patients perceived quality of life index and, at discharge, the people who did not receive the statin had a better quality of life index.

The way that the Daily Mail skewed the results in favour of statins was misleading. For example, by the statement: “The findings suggest the drugs, which cost as little as 40 pence a day, could help to reduce the death toll from a condition that affects around 37,000 people a year in Britain”

The study did not find a reduction in the death rate at all. This is factually incorrect.

And this recent study did not really tell us anything new; it certainly was not newsworthy.

In 2012 there was a detailed review of the use of statins in cases in sepsis, published in the Annals of Intensive Care. The study can be found here:

Statins in the Critically Ill, by Isabelle De Loecker and Jean-Charles Preiser

The authors of this study provide a balanced review of the use of statins in cases of sepsis and, all things considered, there was no clear evidence of any nett benefit associated with the use of statins.

The Daily Mail article also took the opportunity to portray statins as cheap, by referring to “a 40p statin”. I have complained about this many times before, but I must say it again - statins are not cheap, they cost the ‘health’ service in the UK 450 million pounds each year, not to mention the costs of administering the cholesterol test itself, which probably doubles the cost.