Cholesterol, statins and heart disease 

Pharmaceutical companies have found Ancel Keys 1953 hypothesis that high fat diet = high cholesterol = heart disease very rewarding financially – unfortunately it looks as though he was wrong. His hypothesis has become completely ingrained in the thinking of the media, food manufacturers, pharmaceutical manufacturers, the government, the medical profession and most people in the western world and has turned into big business which will go a long way to protect itself. Ancel Keys was the Director of the Laboratory of Physiological Hygiene at the University of Minnesota. He used data from seven countries to show that the higher the dietary fat consumption, the higher the blood cholesterol levels, the greater the risk of heart disease. Unfortunately in order to support his hypothesis, he ignored data from many other countries and cultures which would have disproved it.

This information was gratefully received by food manufacturers who produced chemical fat free spreads, by governments concerned at the increasing rate of heart disease who told everyone they must eat less fat, and by pharmaceutical companies who produced statin drugs which were to be used as mass medication for anyone considered to be at risk of heart disease. 

However there were dissenters who believed that the hypothesis was wrong. They found plenty of evidence that had been conveniently ignored. The famous one is of the study by Dr George Mann, professor of medicine and biochemistry at Vanderbilt university in Tennesee. In the 1970's he studied the Masai in Kenya and found a group of people who ate milk, meat and fat, and had virtually a zero rate of heart disease. His resulting article in the New England Journal of Medicine described the diet-heart hypothesis as “the greatest scam in the history of medicine”

Dr Malcolm Kendrick has done a 14 country study looking at the correlation between saturated fat consumption and heart disease, and, using figures from the WHO, found that the seven countries with lowest saturated fat consumption had the highest rates of heart disease. (1)

The Framingham study – conducted over 49 years – has found that high intake of saturated fats reduced the rate of strokes and coronary heart disease. The Multiple Risk Factor Intervention Trial involving 361,662 men where cholesterol consumption was cut by 42% and saturated fat consumption by 28%, had no effect on heart disease morbidity or mortality. In fact, a later study found that those who followed a cholesterol lowering diet were twice as likely to die of heart disease as those who didn't (2,3). 

Cholesterol is important to cellular health and many studies show its protective benefits, with elderly people who have high cholesterol levels living longer than those with low levels. Eleven out of eighteen studies of elderly people found that high cholesterol is not a risk factor for coronary heart disease – and the other seven studies found that it wasn't a risk factor in early mortality from any cause. Studies have also found that high cholesterol is not a risk factor for women, so it would appear that there are few people for whom it is a risk factor. The Lancet, in 1995, published a study of 450,000 people, and concluded that there was no association between blood cholesterol and stroke. 

Several studies have shown higher mortality from cardiovascular disease with low cholesterol levels – this includes low total lipids, total cholesterol, LDL and HDL – the largest study to date is one of over 1000 patients with heart disease at UCLA in Los Angeles – this found much higher mortality over five years from those with low cholesterol (4). 

A Dutch study of 1200 individuals over 65 looking at the relationship between cholesterol levels and mental function found, over six years, lower levels were associated with a reduction in cognition and information processing speed (5).

Most studies of young and middle aged men have found high cholesterol levels to be a risk factor for heart disease – these men are often highly stressed, another risk factor by itself, and cholesterol is used as building material for many stress hormones. So the treatment required is for stress rather than cholesterol. 

Cholesterol is required for proper brain and nerve function; endocrine gland function; blood vessel integrity; absorption of fat soluble vitamins eg vit D. Vitamin D contains cholesterol, and it protects against multiple sclerosis and all diseases resulting from lowered immunity including cancer and HIV.

 Cholesterol is produced by the liver, and levels are regulated by the liver. A healthy liver will be better able to regulate cholesterol levels. Increased amounts of cholesterol are produced by the liver in response to tissue trauma due to physical injury or inflammation which requires cholesterol as part of the healing process. This is the process that occurs in atherosclerosis, where the cholesterol containing plaques that form in arteries are a direct result of a direct irritation of the tissue by infection, toxins of some other inflammatory process. Many potential causes of this irritation have been proposed  - diabetes, trans fatty acid consumption, high homocysteine levels, stress, and viral and bacterial infection, particularly cytomegalovirus and chlamydia.   

Statins, medication prescribed largely to reduce cholesterol levels, do appear to have  benefits for some of those with cardiovascular disease – but it appears not to be due to their cholesterol lowering ability but due to their anti inflammatory action and blood-thinning effects. Also the actual benefit is minimal – it has been calculated if statins were taken for 30 years, the average increase in lifespan would be 2 months and this benefit would only be seen in men with pre-existing heart disease(6). 

Those who have been shown not to benefit from statins are the elderly, men without existing heart disease and women – which covers quite a few of those on statins. Unfortunately, GPs in the UK are actively encouraged to get cholesterol levels as low as possible, and they are paid if they can achieve this in a high enough percentage of their practice population. Statins are currently the most expensive single item of drug expenditure to the NHS, which together with all the unnecessary cholesterol tests and payments to GPs, makes them an enormous drain on the NHS. 

Statins may not be required, and have the potential for side effects including liver damage, peripheral neuropathy, joint and muscle pain, and muscle weakness, including heart muscle. All these problems are appearing in ever increasing numbers in those on statins. Consultant rheumatologist Ian Morris has seen increasing incidence of patients with severe musculo-skeletal effects due to statin use. He considers that the evidence in favour of statins is based on studies sponsored by pharmaceutical companies which has been subject to statistical manipulation and selective presentation(7). 

Statins work by inhibiting enzymes required for cholesterol production, and also co-enzyme Q10 production – the latter is vital for intra cellular energy production, and has been shown to be depleted by statins. It is vital to supplement with co-Q10 for anyone taking statins – those without symptoms should take 50-100mg daily, and up to 150mg with symptoms, which can take some months of statin use before they appear. Foods with high co-Q10 levels include organ meats, nuts, sesame seeds, oily fish and broccoli. 

Management and prevention of heart disease

The natural healing approach is  to deal with any cause of inflammation in the body. This is likely to be dietary –  food intolerances and over acidic diets – so alcohol, caffeine, red meat, trans fatty acids (see below), dairy and wheat will need to be reduced, and maybe cut out altogether if there is a food intolerance. Antioxidants are important as they will reduce any inflammatory processes in the circulatory system.  For example pomegranate juice has been found to be effective against atherosclerosis, inflammation and high cholesterol levels. 

Liver function also needs to be addressed as an inefficient liver will not clear up excess blood fats.

High stress levels involve the hypothalamic-pituitary- adrenal glands (HPA axis) which produce the hormones (including cortisol and adrenaline) needed to deal with the stress – insulin is part of the calming down, or opposing action after stress has been dealt with. With constant stress levels this process doesn't have a beginning and an end, it becomes constant. High cortisol levels result in the deposition of visceral fat in the abdomen, raised blood pressure, lowered immunity and raised blood sugar and insulin levels – in other words metabolic syndrome X – heart disease and diabetes. Other causes of high cortisol levels include steroid use, depression, smoking and spinal cord injury.  

A low GI (glycaemic index) diet has been shown to significantly reduce cholesterol levels, specifically LDL levels – it also reduces the risk of diabetes, improves insulin sensitivity in diabetics, and reduces the damaging effects of highly variable blood sugar level. C-reactive protein – a measure of inflammation in the body – is significantly decreased by weight loss and low GI diet. So avoid white and processed foods; avoid sugar, honey, maple syrup, agave syrup; have no more than 3 pieces of fruit daily, and only with a protein food so you avoid sugar surges.
Trans fatty acids, the chemically changed oils developed by the cholesterol reduction industry, have been found not only to increase cholesterol levels, but also to cause atherosclerosis, damage heart muscle, the immune system and cause cancer and infertility – despite all this, vegetable oils and margarines are still being promoted as heart healthy. It has been estimated that the average adult in the West eats 15-20g of trans fats daily – from trans fats found in baked, fried and processed foods.

Natural oils and fats, especially those with relatively high omega 3 concentrations – saturated and unsaturated – do not have this detrimental effect on the body, they are actively beneficial. Oils from fish are especially high in omega 3's, as are oils from hemp seed and linseeds. A Japanese study reported in the Lancet in 2007 found that two servings of oily fish per week, or 900mg/day of EPA and DHA offered the same level of protection as statins . Butter, olive oil, flaxseed oil and coconut butter are all good for you. Walnuts are exceedingly good. Christine Herbert

  1. The Great Cholesterol Con , Dr Malcolm Kendrick 2007 pub. John Blake

  2. Kannel WB, Gordon T. The Framingham diet study Washington DC 1970

  3. Werko L. Analysis of the MRFIT screenees. J.of Int.Med.237, 507-18, 1995

  4. Horwich TB et al. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J of Cardiac Failure 8,216-224, 2002

  5. van den Kommer TN et al – total cholesterol and oxysterols: early markers for cognitive decline in the elderly. Neurobiology of Aging 2007, September 19

  6. as (1) p 193

  7. letter to the Independent newspaper 31st July 2007