So what's the truth about Cholesterol

[RoyG]

Cholesterol in the bloodstream comes in two main forms: ‘low density lipoprotein’ (LDL) cholesterol and ‘high density lipoprotein’ (HDL) cholesterol. Conventional wisdom tells us that LDL cholesterol is responsible for accumulation of fat on the inside of our arteries, and is therefore often dubbed ‘bad’ cholesterol. We’re also told that HDL cholesterol is responsible for the transport of cholesterol away from the arteries and, being associated with a reduced risk of heart disease, is therefore dubbed ‘good’ cholesterol. In recent years, there has been particular emphasis on the ‘need’ to get LDL levels as low as possible. A major push regarding this came in 2004, when the National Cholesterol Education Program (NCEP) in the US published its guidelines regarding cholesterol management. While the medical profession has been quick to act on its advice, not all members of the medical community have been so enthusiastic. For example, authors of an independent review of the NCEP’s recommendations concluded, ‘… we found no high-quality clinical evidence to support current treatment goals for [LDL] cholesterol’. The authors went on to question the safety of this practice. In the UK, official recommendations are for cholesterol levels to be lower than 5.0 mmol/ l. Yet average cholesterol levels in the UK are about 5.5 mmol/ l. So, in effect what we’re being told is that a natural and essential body constituent at normal levels is causing disease and death. Does this really make sense? There have been accusations that cholesterol policy has been influenced by the pharmaceutical industry. Support for these concerns comes from the fact that, of the nine members of the NCEP panel, all but one had financial conflicts of interest that were not declared at the time the guidelines were published.

Is Cholesterol Reduction Actually Beneficial? Much of the justification for cholesterol reduction comes from studies in which the cholesterol-reducing drugs known as ‘statins’ have been shown to reduce heart disease risk. However, while statins do indeed reduce cholesterol, they have a number of other properties, too, including anti-inflammatory action, as well as an ability to reduce clotting in the blood. Could it be that the statins reduce heart disease risk through mechanisms that have nothing to do with cholesterol? Support for this concept comes from several lines of evidence, including: Statins reduce cardiovascular disease risk in individuals who have ‘normal’ or even ‘low’ cholesterol levels. Statins substantially reduce the risk of stroke, despite the fact that raised cholesterol is a weak or non-existent risk factor for stroke. More intensive cholesterol reduction does not necessarily lead to improved outcomes in terms of disease or disease markers. Also, if cholesterol reduction does indeed have broad benefits for health, we would expect to see positive effects from cholesterol-reducing strategies in terms of overall risk of death. In a meta-analysis of a variety of cholesterol-reducing strategies, including diet and various classes of drugs and diet, only statins were found to reduce mortality. One type of blood fat modifying drug known as ‘fibrates’ was shown in this meta-analysis to increase the risk of death in healthy people.

Briffa, Dr. John (2012-01-05). Escape the Diet Trap (Kindle Location 1981). Harper Collins, Inc.. Kindle Edition.

It just gets sooooooooooo confusing any body got any comments on above passage before my statins go in the bin :crazy: :crazy:

 

[SouthernGeneral6512]

Not always a bad thing

http://www.bbc.co.uk/news/health-18456749

 

[cuillie]

Hello RoyG, yes im feeling much the same as you, and wondering about ditching the statins. I tackled my GP yeasterday about them as she said that it was nothing to do with high cholesterol that I was on statin it was to do with the diabetes, that somehow a diabetic body is different to undiabetic bodies and we are at higher risk, even although cholesterol is not high. So I am utterly confused, but I can't find any info that secifically related to diabetes.

 

[))Denise((]

After a few weeks of dithering whether to ditch the statins as they have reduced my total cholesterol from 5.2 to 3.0, I've decided to halve my dose to 20mg of simvastatin and see what happens at my next test. Apparently they have anti-inflamatory properties and thats what helps us, but as a woman, I'm still not sure they are doing me any good.

 

[librarising]

RoyG wrote
It just gets sooooooooooo confusing any body got any comments on above passage before my statins go in the bin

Also from Dr Briffa :

"The most comprehensive account of statin side-effects I can find was published last year in the British Medical Journal [3]. Known side-effects of statins include muscle weakness and/or pain (myopathy), liver damage , kidney failure and cataracts. Here, in summary, are the findings of this review:

For every 10,000 women at high risk of CVD [cardiovascular disease] treated with statins, we would expect approximately 271 fewer cases of cardiovascular disease, 8 fewer cases of oesophageal cancer, 23 extra patients with kidney failure, 307 extra patients with cataracts; 74 extra patients with liver dysfunction; and 39 extra patients with myopathy.

For every 10,000 men at high risk of CVD treated with statins, we would expect approximately 301 fewer cases of cardiovascular disease, 9 fewer cases of oesophageal cancer, 29 extra patients with kidney failure, 191 extra patients with cataracts; 71 extra patients with liver dysfunction; and 110 extra patients with myopathy.

This study focused specifically on data relating to individuals deemed to be at high risk of cardiovascular disease. Many individuals who take statins are actually not at high risk of cardiovascular disease. For these, benefits are likely to be significantly lower than those elucidated in this study (while risks are likely to be about the same).

But look at those figures for a moment. Two things jump out to me:

Of 10,000 high-risk individuals, only about 300 will benefit – that’s 3 per cent. That means, of course, 97 per cent will not benefit. The number of people who benefit is roughly matched by those who will get a serious adverse effect. Hands up who wants to take a statin now?"

http://www.drbriffa.com/2011/11/08/stat ... they-help/

I also believe statins have other negative effects, and that the best way to ward off CVD is to eat healthily and exercise.
GPs see diabetes + high cholesterol + (possibly) metabolic syndrome = statins.
A safe advice route for them to go legally :roll:

Swings and roundabouts come to mind.

Geoff

 

[Sid Bonkers]

Everyone interested in cholesterol and the Lipid Hypothesis should read this potted history of events from the 1950's to today which I found on the web page of the British Atherosclerosis Society of a lecture given by Gilbert Thompson.

Gil Thompson is Emeritus Professor of Clinical Lipidology at Imperial College London.

Link to the lecture here http://www.britathsoc.org/bas_gil_thompson_talk.html


A couple of extracts:

The proving of the lipid hypothesis
Clear and unequivocal proof of the lipid hypothesis came in 1994 when the Scandinavian Simvastatin Survival Study (4S) conclusively demonstrated that lowering LDL cholesterol significantly reduced both total and coronary mortality without increasing non-cardiac mortality. A recent meta-analysis by the Cholesterol Treatment Trialists’ Collaboration of 14 statin trials between 1994-2004 showed a 20% decrease in coronary mortality for every 1 mmol/L decrease in LDL cholesterol...


However, although the lipid hypothesis may have been proved several controversial issues remain concerning cholesterol-lowering. These include the validity or otherwise of CETP inhibition; the efficacy and safety of ezetimibe; the possible atherogenicity of dietary plant sterols; and the question of how much LDL cholesterol should be lowered to achieve maximal benefit.

And

Conclusions
I’d like to end by quoting the inimitable Donald Rumsfeld who said in 2002:

"That there are known knowns - things we know that we know".
I consider that the lipid hypothesis comes under this heading.

"There are known unknowns - things we know we don’t know".
Controversial issues still needing an answer fall into this category.

"But there are also unknown unknowns - things we do not know we don’t know."
This last category presumably refers to questions of the future, which are impossible to predict. Who would have thought 50 years ago, when this Society was founded, that today it would be discussing nuclear receptors and atherosclerosis? As for 50 years hence, that’s an unknown unknown to which I shall never know the answer!

So believing that any one person has all the answers could be a very dangerous thing to believe, just as in most things.

 

[librarising]

Sid Bonkers wrote
So believing that any one person has all the answers could be a very dangerous thing to believe, just as in most things.

Absolutely agree Sid.
Can't agree, however, that there is only one person out there disagreeing with the lipid hypothesis.

Dr Briffa is probably the person responsible for setting me off on my journey of discovery about medical lies, medical **** lies, and medical statistics.
I was DUMBSTRUCK (well almost) when he wrote "saturated fat is good for you." Just thought that can't be true.
At that point, as far as I knew, he was a lone voice.
That I now know to be far from the truth, and anyone with the time to explore will find that out.

I would stress the importance of approaching this with an open mind. Then we might see what's there to be seen, rather than the human propensity to see what we want to see.
Which is not to say I'm right and others are wrong.
Simply that we need to cut through the **** :

A recent meta-analysis by the Cholesterol Treatment Trialists’ Collaboration of 14 statin trials between 1994-2004 showed a 20% decrease in coronary mortality for every 1 mmol/L decrease in LDL cholesterol...

When results are given as percentages rather than actual figures, the real benefit of anything can be exaggerated.
e.g.
risk of mortality without statins : 3 in a thousand (made-up figure for illustrative purposes)
risk of mortality with statins : 2 in a thousand. A whopping 33% reduction, apparently demonstrating the effectiveness of statins.

Finding the truth out there can seem to be a fruitless endeavour.
Sometimes it's simpler to find the lies obscuring the truth.

Just clarifying your 'one person' statement.

Geoff

 

[hanadr]

The cholesterol, thing IS CONFUSING Cholesterol is essential, because hormones are made from it.I have read a paper that shows a study where cholesterol below 4 was dangerous to post-menopausal women. [I'm 65!] and my cholesterol runs at about 3 most of the time without statins, which my new doctor would like me to take.
they don't seem to hurt me so I occasionally take one to humour him.
Hana

 

[noblehead]

It just gets sooooooooooo confusing any body got any comments on above passage before my statins go in the bin :crazy: :crazy:

You make a good case for and against statins in your post Roy, I would talk it over with your HCP's before deciding to bin them or not.

 

[RoyG]

Interesting controversy regarding this subject, I am also thinking something is just not quite right regarding the rapidity at which GPs shove these Statins at people. I have seen how the levels have been raised regarding cholesterol level, yet no good evidence for this rise and that being in a short space of time, if it's so detrimental why is it there in the first place? I have always had my doubt as to the effect and purpose of these drugs. I am sure this thread will uncover lots of evidence for the pro's and con's

 

[noblehead]

I am sure this thread will uncover lots of evidence for the pro's and con's

It may well do Roy but at the end of the day it's your call whether to ditch them or not. I was told last year to start statins with a TC of 4.1 but at my recent review my TC was 3.8 and the Endo didn't think I should bother for now, it is confusing as you want to do the best for you and your family but you need to decide the pro's and con's yourself..... taking into account current health and family history etc.

 

[Sid Bonkers]

Can't agree, however, that there is only one person out there disagreeing with the lipid hypothesis.

Dr Briffa is probably the person responsible for setting me off on my journey of discovery about medical lies, medical **** lies, and medical statistics.

You must forgive me Geoff as I dont know anything about Dr Briffa other than mention of him here on the forum but when I look at his web site I see he sells diet books!! And describes himself thus "I’m a naturally-oriented medical doctor, author and speaker. My work is dedicated to providing honest and trustworthy holistic health advice that can be used to combat and prevent illness,"
Now I'm not trying to be controversial here but personally I would take advice from a Professor of Clinical Lipidology and the British Atherosclerosis Society every time over someone who offers diet books and holistic health advice but thats just me I guess.

I was DUMBSTRUCK (well almost) when he wrote "saturated fat is good for you." Just thought that can't be true.
At that point, as far as I knew, he was a lone voice.
That I now know to be far from the truth, and anyone with the time to explore will find that out.

But I have taken the time to explore this and have come to a different conclusion based on clinical science and 60 odd years of history and experience rather than a couple of best sellers

 

[RoyG]

Reading the paper that the link above refers to, it would seem that the known level for cholesterol within the Human body is at best a guess ! And the use of these drugs may be playing a different role as passage above

while statins do indeed reduce cholesterol, they have a number of other properties, too, including anti-inflammatory action, as well as an ability to reduce clotting in the blood. Could it be that the statins reduce heart disease risk through mechanisms that have nothing to do with cholesterol?

But what and were is the solid irrefutable evidence or your smoking Gun that categorically states Hi Cholesterol will Kill you? is there any, Mr Bonkers as you say you would take the word of a Professor of Clinical Lipidology and the British Atherosclerosis Society well what makes them the Gods of Knowledge? Are they right and can they produce the evidence as above, if you have explored this subject perhaps you may be able to produce the evidence that I am asking, if so please share it. The study

Scandinavian Simvastatin Survival Study

again 'grey' what are the figures, how many people? what where the controls in place? what where these peoples diets and other factors? I don't for one minute suggest Dr Briffa is correct, but neither am I saying he is incorrect. On this subject there are many voices out there questioning the validity of these drugs not just Him. Ridicule is not a valid argument!

 

[Dillinger]

I have been a part of the statin/cholesterol discussion on here ever since I joined and I have as a consequence decided not to take them.

Here is a recent review of cholesterol levels, and notice in particular this bit:

"The association with IHD mortality (HR: 1.07; 95% CI: 0.92–1.24) was not linear but seemed to follow a ‘U-shaped’ curve, with the highest mortality <5.0 and ≥7.0 mmol L−1. Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98–1.15) and in total (HR: 0.98; 95% CI: 0.93–1.03) followed a ‘U-shaped’ pattern." My bold.

I'm in the sweet spot of <5.0 and ≥7.0 (where most of the UK is by the way) so I'm happy with that. My other lipids are excellent; i.e. trigs and HDL/total cholesterol ratio.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/

Best

Dillinger

 

[Sid Bonkers]

perhaps you may be able to produce the evidence that I am asking, if so please share it.

Not quite sure why you are bothering to ask me for 'evidence' I am not a doctor nor a scientist neither have I any specialist knowledge about cholesterol just the same as you really, all I am saying is, is it not best to go with 60 years of experience that has already shown that what was thought correct 10, 20, 30, 40 etc years ago is being constantly debunked. Yudkin corrected Keys but was then debunked himself etc etc.

All I believe is go with the 'best advice' of the time, it may not be correct in ten years time but at least is is the currently accepted wisdom and as up to date as it can be. So can I give you evidence, no of course not I wouldnt even try which is why I take no notice of other unqualified people who present 'evidence' to me.

 

[borofergie]

Here is the evidence:
http://summaries.cochrane.org/CD002137/ ... rt-disease

Cutting down you saturated fat intake might reduce your chances of a heart attack, but there is no-evidence that it will influence your mortality.

Clear and unequivocal proof of the lipid hypothesis came in 1994 when the Scandinavian Simvastatin Survival Study (4S) conclusively demonstrated that lowering LDL cholesterol significantly reduced both total and coronary mortality without increasing non-cardiac mortality.

But this is at the heart of the "false" lipid hypothesis:

• Taking statins can reduce your LDL cholesterol
• Taking statins has been demonstrated to improve the mortality of a small subset of individuals

But this doesn't demonstrate that statins work because they reduce LDL cholesterol. It's actually more likely that they help to reduce systematic inflammation (and that the reduce in mortality and the reduce in cholesterol, are side effects of that).

The lipid hypothesis is based on the false assumption that "eating saturated fat" increases your LDL cholesterol which therefore must increase your chances of a heart-attack.

Firstly the "fat in your mouth = fat in your arteries" thing isn't true - paticlarly on a low-carbohydrate diet - and it's much more likely that "carbs in your mouth = fat in your arteries.

Secondly, the role of cholesterol is much more complicated than Ancel Keys thought (60 odd years ago), and we're only just begining to understand how it all works. It seems that quality of cholesterol is far more important than quanitity, and that is also strongly influenced by eating a low-carb diet.

I eat an 80% fat diet. My cholesterol is - if anything - too low.

 

[borofergie]

All I believe is go with the 'best advice' of the time, it may not be correct in ten years time but at least is is the currently accepted wisdom and as up to date as it can be. So can I give you evidence, no of course not I wouldnt even try which is why I take no notice of other unqualified people who present 'evidence' to me.

Scientific consensus doesn't change because of the impact of new evidence, but because those that cling on to the old dogma die.

Luckily the guy you were quoting, looks nearly ready to check out of the debate.

 

[RoyG]

I have been a part of the statin/cholesterol discussion on here ever since I joined and I have as a consequence decided not to take them.

Here is a recent review of cholesterol levels, and notice in particular this bit:

"The association with IHD mortality (HR: 1.07; 95% CI: 0.92–1.24) was not linear but seemed to follow a ‘U-shaped’ curve, with the highest mortality <5.0 and ≥7.0 mmol L−1. Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98–1.15) and in total (HR: 0.98; 95% CI: 0.93–1.03) followed a ‘U-shaped’ pattern." My bold.

I'm in the sweet spot of <5.0 and ≥7.0 (where most of the UK is by the way) so I'm happy with that. My other lipids are excellent; i.e. trigs and HDL/total cholesterol ratio.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/

Best

Dillinger

So from that survey, you would be led to assume that the present clinical guidelines for Cholesterol are wrong and it should be between 5 and 7 mmol/l, so given my current level is 5 mmol which is deemed high by current thinking. I am prescribed Statins (forgetting the diagnoses of type 2) is was on them prior to my diagnoses, that are not needed?

 

[Scardoc]

Scientific consensus doesn't change because of the impact of new evidence, but because those that cling on to the old dogma die.

Nonsense! Of course it does, when the evidence is proven.

"Firstly the "fat in your mouth = fat in your arteries" thing isn't true - paticlarly on a low-carbohydrate diet - and it's much more likely that "carbs in your mouth = fat in your arteries."

The words much more likely indicate that it has not yet been proven so why should scientific consensus change?

"Now I'm not trying to be controversial here but personally I would take advice from a Professor of Clinical Lipidology and the British Atherosclerosis Society every time over someone who offers diet books and holistic health advice but thats just me I guess."

I agree with that. I'm not saying that people who have dedicated their careers to study and specialise in a particular field will get everything 100% correct every time but I have more faith in them than someone who's website invariably directs you to purchase something. We can all research online and read various papers etc but people who specialise in these matters have a deeper understanding.

 

[borofergie]

Scientific consensus doesn't change because of the impact of new evidence, but because those that cling on to the old dogma die.

Nonsense! Of course it does, when the evidence is proven.

No, I'm afraid it doesn't...

In the early 80s Robin Warren and Barry Marshall discovered that peptic ulcers (and some stomach cancers) were caused by a bacteria in the stomach. By 89 they'd developed a cure and had papers published in 5 top peer reviewed journals, but were widely riducled by the mainstream medical community who thought that no bacteria could survive the acid environment of the stomach. In frustration Marhall even infected himself with the bacteria to prove that he would develop an ulcer.

Despite this the medical community refused to change their opinion and ulcers continued being treated with ineffective diets antacids until about 1997, when the consensus suddenly changed and doctors started treating ulcers with antibiotics.

They received the Nobel Prize for Medecine in 2005...
http://en.wikipedia.org/wiki/Barry_Marshall
http://en.wikipedia.org/wiki/Helicobacter_pylori

My point here is that, even in the light of excellent evidence, it takes some time for the consensus to change. Sometimes solutions that were widely riduculed are eventually adopted by the mainstream. That's just the way that science and medicine progress.

"Now I'm not trying to be controversial here but personally I would take advice from a Professor of Clinical Lipidology and the British Atherosclerosis Society every time over someone who offers diet books and holistic health advice but thats just me I guess."

Yeah?

Well I'd rather trust the Cochrane Review than one crusty old Prof at the end of his career:
http://onlinelibrary.wiley.com/doi/10.1 ... 3/abstract