Have we been conned about cholesterol?
By Dr Malcolm Kendrick
Conventional medical wisdom about cholesterol and the role of statins is now being challenged by a small, but growing number of health professionals. Among them is Dr Malcolm Kendrick. A GP for 25 years, he has also worked with the Eurpean Society of Cardiology, and writes for leading medical magazines.
When it comes to heart disease, we have been sold a pup. A rather large pup.
Actually, it is more of a full-grown blue whale. We have all been conned.
If you have got a raised risk of heart disease, the standard medical advice is to take a cholesterol lowering statin drug to cut your chances of having a heart attack because, as we all know, cholesterol is a killer.
Indeed, many of you already believe that you should take statin for the rest of your natural lifespan.
Nearly everybody is in agreement about the need to lower your cholesterol level. The NHS spends nearly 1 Billion pounds a year on prescriptions for statins and possibly the same amount administering the cholesterol tests, surgery visits and the rest.
But is it all worth it? According to an article being published in the medical journal The Lancet this week, the answer is probably no.
A leading researcher at Harvard Medical School has found that women don´t benefit from taking statins at all, nor do men over 69 who haven´t already had a heart attack.
There is a very faint benefit if you are a young man who also hasn´t had a heart attack-out of 50 men who take the drug for five years, one will benefit.
Nor is this the first study to suggest that fighting cholesterol with statins is bunk. Indeed, there are hundreds of doctors and researchers who agree that the cholesterol hypothesis itself is nonsense.
What their work shows, and what your doctor should be saying, is the following:
· A high diet, saturated or otherwise, does not affect blood cholesterol levels.
· High cholesterol levels does not cause heart disease.
· Statins do not protect against heart disease by lowering cholesterol-when they work, they do so in another way.
· The protection provided by statins is so small as to be not worth bothering about for most people ( and all women ) The reality is that the benefits have been hyped beyond belief.
· Statins have many unpleasant side effects that has been admitted, while experts in this area should be treated with healthy sceptism because they are almost universally paid large sums by statin manufacturers to sing loudly from their hymn sheet.
So how can I say saturated fat doesn´t matter when everybody knows it is a killer? Could all those millions who have been putting skinless chicken and one per cent fat yoghurts into their trolleys really have been wasting their time?
The experts are so busy urging you to consume less fat and more statins that you are never warned about the contradictions and lack of evidence behind the cholesterol con.
In fact, what many mayor studies show is that as far as protecting your heart goes, cutting back on saturated fats makes no difference and, in fact, is more likely to do harm.
So how did fat and cholesterol get such a bad name? It all began 100 years ago, when a researcher found feeding rabbits ( vegetarians ) a high cholesterol carnivore diet blocked their arteries with plaque.
But it took off in the fifties with the Seven Countries study by Ancel Keys, which showed that the higher the saturated fat intake in a country, the higher the rate of heart desease.
The countries he chose included Italy, Greece, the USA and the Netherlands. But why these particular ones?
Recently I did my own 14 countries study using figures from the World Health Organisation, and found the opposite.
Countries with the highest saturated fat consumption? Austria, France, Finland and Belgium had the lowest rate of deaths from heart disease, while those with the lowest consumption, Georgia, Ukraine and Croatia had the highest mortality rate from heart disease.
Added to this, the biggest ever trial on dietry modification put 50 million people on a low saturated fat diet for 14 years.
Sausages, eggs, cheese, bacon and milk was restricted. Fruit and fish, however, were freely available. I am talking about rationing in Britain during and after World War Two. In that time, deaths from heart disease more than doubled.
Even more damning what happened in 1988. The surgeon General´s office in the US decided to gather all evidence saturated fat to heart desease, silencing any nay-sayers for ever.
Eleven years later, however, the project was killed. The letter announcing this stated that the office "did not anticipate fully the magnitude of the additional expertise and staff resources that would be needed"
After eleven years, they needed additional expertise and staff resources? What had they been doing? If they found a scrap of evidence, you would never have heard the last of it.
Major trials since have been no more successful. One involved nearly 30.000 middle aged men and women in Sweden, followed for six years.
The conclusion? Saturated fat showed no relationship with cardiovascular disease in men. Among the women, cardiovascular mortality showed a downward tren with increasing saturated fat intake. In other words, the more saturated fat, the less chance of dying from heart desease.
Even stronger evidence of the benefits of increased fat and cholesterol in the diet comes from Japan. Between 1958 abd 1999, the Japanese doubled their protein intake, ate 400 per cent more fat and their cholesterol levels went up by 20 per cent.
Did they drop like flies? No. Their stroke rate, which had been the highest in the world, was seven times lower, while deaths from heart attacks, already low, fell by 50 per cent.
It´s a bit of a paradox, isn´t it? That´s one of the features of the dietary hypothesis - it involves a lot of paradoxes.
The most famous is the French Paradox. They eat more saturated fat than we do in Britain, they smoke more, take less exercise, have the same cholesterol/LDL levels, they also have the same average blood pressure and the same rate of obesity.
And you know what? They have one quarter the rate of heart desease than we do.
The official explanation is that the French are protected from heart desease by drinking red wine, eating lightly cooked vegetables and eating garlic.
But there is no evidence that any of these factors are actually protective. None. By evidence I mean randomised, controlled clinical study.
But you don´t have to look to foreign countries to find paradoxes - the biggest one is right here at home. Women are about 300 per cent less likely to suffer heart disease than men, even though on average they have higher cholesterol levels.
By the nineties, millions of women were being prescribed HRT to stave off heart disease. Then came the HERS trial to test the notion. It found that HRT increased the risk of heart disease.
So what to do? Put them on statins, bring their cholesterol down below 5.0 mmol is the official advice.
But, as the Lancet article emphasises, women do not benefit from statins. The phrase "Statins do not save lives in women" should be hung in every doctor´s surgery.
But it´s not just hugely wasteful handling out statins to women and men who are never going to benefit. it also exposes them to the risk of totally unnecassary side effects.