The Great Cholesterol Myth (4 page)

Lowering cholesterol has a very limited benefit in populations other than middle-aged men with a history of heart disease.

By now my conversion from cholesterol true believer to cholesterol skeptic is complete. I still prescribe statins—but only on occasion, and almost exclusively to middle-aged men who’ve already had a first heart attack, coronary interventioin (e.g., bypass, stent, angioplasty), or coronary artery disease.

I’ve come to believe that cholesterol is a minor player in the development of heart disease and that whatever good statin drugs accomplish has very little to do with their cholesterol-lowering ability. (We discuss this at great length in
chapter 6
, “The Statin Scam.”) Statin drugs are anti-inflammatory, and their power to reduce inflammation is much more important than their ability to lower cholesterol. But we can lower inflammation (and the risk for heart disease) with natural supplements, a better diet, and lifestyle changes such as managing stress. Best of all, none of these come with the growing laundry list of troubling symptoms and side effects associated with statin drugs and cholesterol lowering.

So there you have it. Two individuals with very different journeys arriving at the same conclusion. And because that conclusion may be pretty hard to swallow if you’ve been brainwashed by the cholesterol establishment—and who hasn’t?—it might be helpful to take a moment and talk about a study we alluded to earlier—the Lyon Diet Heart Study.

In the early 1990s, French researchers decided to run an experiment—known as the Lyon Diet Heart Study—to test the effect of different diets on heart disease.
⁴

They took 605 men and women who were prime candidates for heart attacks. These folks had every risk factor imaginable. All of them had already survived a first heart attack. Their cholesterol levels were through the roof, they smoked, they ate junk food, they didn’t exercise, and they had high levels of stress. People like this give insurance underwriters nightmares. To be frank, these folks were “dead men walking.”

The researchers divided the participants into two groups. The first group was counseled (by the research cardiologist and the dietician during a one-hour session) to eat a Mediterranean-type diet which emhasizes fresh fruit and vegetables, whole grains, legumes, nutes, healthy fats like olive oil, and seafood. The second group was the control group and
received no dietary advice from the investigators but was advised, nonetheless, to follow a
prudent diet
by their attending physicians.

What was this prudent diet, you ask? Pretty much the standard (and, as we shall see, useless) diet that doctors have been recommending for decades: Eat no more than 30 percent of your calories from fat, no more than 10 percent from saturated fat, and no more than 300 mg of cholesterol a day (about the amount in two eggs). So what happened with the study?

Actually, it was stopped.

Why? Because the reduction in heart attacks in the Mediterranean diet group was so pronounced that the researchers decided it was unethical to continue. To be precise, the Mediterranean diet group had a whopping 70 percent reduction in deaths and an even more impressive 76 percent reduction in cardiovascular deaths. What’s more, angina, pulmonary embolism, heart failure, and stroke were also much lower in the intervention group. A huge victory for the Mediterranean diet and a big dunkin’ for the prudent diet.

So what happened to these folks’ cholesterol levels? Gosh, you’d imagine they dropped like crazy, because so few of them were dying of heart disease.

Um, not so much.

Their cholesterol levels
didn’t budge
.

Let’s repeat that one more time: a 76 percent reduction in deaths from heart disease but not a whit of change in cholesterol levels. Neither in their
total
cholesterol levels
nor
in their levels of LDL (the so-called “bad” cholesterol). You’d think this would shake up the cholesterol establishment a bit, wouldn’t you?

Think again. The prestigious
New England Journal of Medicine
refused to publish the study. (It was eventually published in another highly regarded medical journal,
The Lancet.
) We have a hunch that the reason the
New England Journal of Medicine
didn’t publish the study was precisely because there was no difference in cholesterol levels between the two groups of people, the ones who did so well and the ones who did not. The American medical establishment is so firmly locked into the notion that cholesterol and fat cause heart disease that any inconvenient evidence to the contrary—and there is a massive amount of it, as you will soon find out—has to be ignored or explained away.

Lower heart disease rates? And no movement in cholesterol numbers?

Something has to be wrong!

Actually something
was
wrong, but not with the study. What was—and is—wrong is the blind belief that cholesterol simply makes a huge difference.

Not convinced? Fast-forward to a drug study completed in 2006, the widely publicized ENHANCE trial.
⁵
If you were following the news in 2008 you couldn’t have missed this one, because it made the front pages of the newspapers and all of the television news shows. Here’s what happened.

A combination cholesterol-lowering medication called Vytorin had been the subject of a huge research project, the results of which were finally coming to light and receiving an enormous amount of negative attention. One of the many reasons for this negative
attention was the fact that the companies jointly making the drug (Merck and Schering-Plough, who’ve since merged) waited almost two years before releasing it.

No wonder. The results stunk. Which was the
other
reason this drug test made the front pages.

The new “wonder” drug lowered cholesterol just fine. In fact, it lowered it
better
than a standard statin drug. So you’d think everyone would be jumping for joy, right? Lower cholesterol, lower heart disease, let’s have a party for the shareholders.

Um, not quite. Although the people taking Vytorin saw their cholesterol levels plummet, they actually had
more
plaque growth than the people taking the standard cholesterol drug. The patients on Vytorin had almost twice as great an increase in the thickness of their arterial walls, a result you definitely don’t want to see if you’re trying to prevent heart disease.

So their cholesterol was wonderfully lowered and their risk for heart disease went up—shades of “the operation was a success but the patient died.”

There are countless other examples, many of which we’ll discuss later on, but let’s just mention one of them right now. It’s known as the Nurses’ Health Study, and it’s one of the longest-running studies of diet and disease ever undertaken. Conducted by Harvard University, the study has followed more than 120,000 females since the mid-1970s to determine risk factors for cancer and heart disease.
⁶
In an exhaustive analysis of 84,129 of these women, published in the
New England Journal of Medicine
,
⁷
five factors were identified that significantly lowered the risk for heart disease. In fact, wrote the authors, “Eighty-two percent of coronary events in the study . . . could be attributed to lack of adherence to (these five factors).”

Are you ready for the five factors?

1. Don’t smoke.

2. Drink alcohol in moderation.

3. Engage in moderate-to-vigorous exercise for at least half an hour a day on average.

4. Maintain a healthy weight (BMI under 25).

5. Eat a wholesome, low-glycemic (low-sugar) diet with plenty of omega-3 fats and fiber.

Wait, didn’t they miss something? Where’s the part about lowering cholesterol?

Oh. It’s not there. Never mind.

Of course, there’s not roughly $30 billion plus a year to be made peddling that advice (a number that represents the gross revenue from statin drugs alone), and popping a pill is a lot easier than changing your lifestyle, but there it is. The inconvenient fact that lowering cholesterol has almost
no effect
on extending life is simply ignored by the special interests that profit enormously from keeping you in the dark.

As the writer Upton Sinclair said, “It is very difficult to get a man to understand something, when his salary depends upon his not understanding it.”

CHAPTER 2

NOW LET’S TALK ABOUT YOU FOR A MOMENT.

Unless you’re just an information junkie, there’s a good chance that you’re reading this book because you have something at stake here. Let us guess: You’re concerned about
your
cholesterol.

Maybe you’re a woman whose doctor has read you the riot act because your cholesterol is approaching 300 mg/dL, and your doc has convinced you that you’ll drop dead of a heart attack if you don’t go on medication right away.

Maybe you’re a middle-aged man who has already had a heart attack, and your doctor is adamant about putting you on a cholesterol-lowering drug.

Or maybe you’re a fit guy in your sixties whose cholesterol is 240 mg/dL and whose doctor is “worried” about that number.

However, only
one
of the three hypothetical cases listed above has any business being on a cholesterol-lowering drug. Can you guess which one? Don’t worry: By the time you finish this book, you’ll not only know the answer, you’ll also know a heck of a lot more about cholesterol than most doctors in America. And, no, we don’t make that statement lightly.