The “Lipid Hypothesis”
Are you worried about your blood cholesterol (TC) level? For many it is a fact of life (and death) that if you have a high TC level this means an increased risk of dying from heart disease. Hence it follows that steps should be taken to lower it in order to reduce the risks. It is this rationale which underpins the case for using statins and for the dietary advice to reduce the consumption of saturated fats (SFAs) and to increase that of polyunsaturated fats (PUFAs). A recent paper in the BMJ is a further addition to the huge amount of evidence that challenges the validity of this hypothesis (1).
This is a re-examination of the data from the Minnesota Coronary Experiment (MCE) which was a trial done between 1968 and 1973. This was to determine if the replacement of SFAs with a vegetable oil, rich in the PUFA linoleic acid (LA) would reduce the incidence of coronary heart disease (CHD) by lowering the TC. The original report was published in 1989 (sometime after the end of the study!) (2). In this latest report, the researchers had access to data, which had not been used in the preparation of the earlier one. Information was obtained for 2355 individuals with an age range from 20 to 97 years. Slightly more than half were women and 25% were 65 or older. The average TC was 208 mg/100 ml (5.39 mmol/L). In order to lower the TC, the diet was altered by reducing the SFA from 18.5% to 9.2% of Calories. The Increase in PUFA was largely due to LA which increased from 3.4% to 13.2% of Calories. During the study there was also a small increase in the LA content of the control diet from 3.4% to 4.7%.
The researchers have attempted to answer three questions.
Did the MCE intervention lower serum cholesterol?
The answer to this question was a definite YES. There was of 31.2 mg/100mg (0.8 mmol/L). As expected, there was also a small reduction in TC of the controls because of the increase in LA in the diet.
Did the MCE intervention reduce risk of death?
This is the $64,000 question. If the conventional wisdom is correct then there should be a substantial drop in the risk of dying from heart disease. However my big gripe about this is that I need to be sure that there is not an increased risk of dying from some other cause. So I am only interested in the impact on all-cause mortality (ACM). It was found that there was no reduction in ACM for those who changed their diet and there were strong indications that there was actually increased mortality in those aged over 65 years.
Was the change in serum cholesterol related to risk of death?
In contrast to what would be expected according to conventional wisdom, the reduction in TC of 30mg/100mg (0.78 mmol/L) was accompanied by an increase in death rate of 22%. Even more disturbing is that was restricted to those who were over 65 years old. In this group, the ACM was increased by 35%. Post-mortems were done on some of the participants and the results showed that the incidence of myocardial infarcts in those who altered their diet was double that of those in the controls.
Not just an isolated example
While the advocates of the Lipid Hypothesis may try to brush this off as an isolated study, the reality is that it fits in perfectly with lots of other information, which all point to the same conclusion. I have described many different studies on the relationship between TC and ACM in a previous blog (3). I concluded:
“Without exception all-cause mortality is highest in those with the lowest levels of TC. In older people those with the highest cholesterol have the highest survival rates, irrespective of where they live in the world. The picture which emerges is totally consistent.”
The evidence continues to pile up
More recently in June 2016, BMJ Open published a meta-analysis based on 19 carefully selected studies, which involved just over 68,000 participants (4). This highly relevant because the focus is on the LDL-Cholesterol (LDL-C) the so-called “bad” one. The analysis found that there was either a lack of an association or an inverse association between LDL-C and mortality among people older than 60 years. In almost 80% of the total number of individuals, LDL-C was inversely associated with ACM and with statistical significance. To make it quite clear what this means is that those with high values for the LDL-C, the risk of dying (from any cause) is less than with those who have lower values. Or to put it another way, those who comply with the official guidelines for LDL-C are more likely to die than those who are regarded as “at high risk for heart disease” because they have a raised LDL-C.
Results like this have been emerging for years. As long ago as 1992, there was a conference to consider a whole series of investigations which came to similar conclusions (5). These were just brushed aside because they posed a threat to the National Cholesterol Education Program (NCEP) in the USA, which was already in place. The explanation put forward was that the low cholesterol was caused by the incipient disease. This possibility was eliminated by excluding data for people who died in the first 4 or 5 years.
A more likely explanation is that the high cholesterol is beneficial and that low values increase susceptibility to diseases that prove to be fatal. This view is supported by the fact that LDL-C binds to various microorganisms and their toxic products thereby inactivating them. Hence those with high LDL-C would have some protection, which would not apply to those with low values.
Conclusion
The implications of this knowledge are absolutely mind-blowing. If these results are reliable and there is so much from a variety of different sources, they really do have credibility, then it is totally irresponsible to advise them to lower their cholesterol. It is comparable to advising a person with gold-plated final year salary scheme pension to give it up for something that is much more risky. Those in a position to take effective action to address this fiasco, to put it mildly, have been totally irresponsible. Perhaps CORRUPT would be more accurate to describe what is going on. All I can say is that if you are advised to reduce your cholesterol by diet or drugs, then show your adviser the information shown here, which all comes from high quality authoritative sources.
References
- C E Ramsden (2016) http://www.bmj.com/content/bmj/353/bmj.i1246.full.pdf
- I D Frantz Jr et al. (1989). Arteriosclerosis 9 129-35 doi:10.1161/01.ATV.9.1.129
- V Wheelock http://vernerwheelock.com/179-cholesterol-and-all-cause-mortality/
- U Ravnskov et al (2016) http://bmjopen.bmj.com/content/6/6/e010401.full
- D Jacobs et al (1992) Circulation 86 pp 1046-1060
Verner,
We are back to the old story of vested interests, The evidence is overwhelming that cholesterol is not the problem and clowns such as Rory Collins who still cling to like a dog to a rag to the belief (stated – but does he really believe it?) that cholesterol is the problem and that statins are the answer are directly contributing to the poor health of people who mistakenly believe them. Study after study after study clearly shows that the higher your cholesterol the longer you live and the lower (especially when artificially reduced by drugs) the greater your risk from ACM (with increased risk of cancer and stroke) plus a raft of serious medical conditions related to statin use.
The stupidity of the dietary advice to not consume natural foods that our bodies require and replace them with manufactured “foods” (especially highly refined carbohydrate and excessive Omega-6 vegetable oils) to “lower your cholesterol” has caused immense damage to the health of people who have replaced natural food with artificial food. I feel especially sorry for those that see themselves as health conscious and have deliberately chosen to follow this advice. The evidence is all around us that the dietary advice of the past few decades is totally wrong (obesity and diabetes being perhaps the most obvious manifestations) but still the vested interests push it. Really is the definition of stupidly to continue to push a policy that is so clearly wrong but of course there’s serious money to be made by the food and pharmaceutical industries so I don’t see change occurring any time soon.
WE are on the same wavelength. At least Fiona Godlee and the BMJ have the guts and integrity to tackle Rory Collins et al. More power to their elbows. You might like this
http://static.www.bmj.com/sites/default/files/copedocuments.pdf
V
Verner,
Thanks for that link. It is gratifying that there are those that will challenge the status quo. I apologise if you are already aware of this but if not this is an indication of what we are up against.
Dr Kendrick GP was one of the eight signatories, along with Sir Richard Thompson, president of the Royal College of Physicians, Clare Gerada, a past chair of the Royal College of GPs, Prof Simon Capewell, clinical epidemiologist at the University of Liverpool, Prof David Haslam, chair of the National Obesity Forum, Dr Aseem Malhotra, Dr JS Bamrah, medical director of Manchester Mental Health and Social Care Trust, and Prof David Newham, director of clinical research at the Mount Sinai School of Medicine in New York that sent a letter to the National Institute for Health and Care Excellence (NICE) plus the health secretary, Jeremy Hunt with a predictable response https://drmalcolmkendrick.org/2014/06/27/another-backlash-begins/ with Dr Kendrick covering it here https://drmalcolmkendrick.org/2014/09/30/you-are-killing-my-patients-again/ . Individuals also occasionally have their say https://drmalcolmkendrick.org/2014/10/11/silence-was-the-stern-reply-2/ with the not unexpected three monkeys response (the arrogance of these Flat -Earthers knows no bounds).
I think these people (who support statins) are aware of the truth (difficult to understand how anyone with a functioning brain couldn’t be) but they are so entrenched and captured by their stated beliefs that to recant now would be professional and financial suicide. Such a pity that modern society places so little value on the truth and honest debate. Max Planck was right: A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.
Barry, absolutely spot on. V
At a time when NHS resources are so stretched it is appalling that we are spending so much so unnecessarily on statins. Do they have any benefits at all?
Two simple changes – reducing our reliance on statins and getting people off a high carb low fat diet – could save the NHS millions.
I have been doing a lot of research on statins due to being put on statins (not for long ) I do eat a lot of organic food and really watch what i consume ,After my blood tests last week ,again i was told to take my
statins ,My own feelings on this is NO WAY , Low carbs is the way i go and i am sorry to say ,i have no trust in being told by Doctors any more . Thank you for the INFO above as i feel it is the truth .Kind Regards .susie.