In my last post, I examined the efficacy and safety of statins. They’re the cholesterol-lowering drugs that tens of millions of Americans are currently taking.

The genesis of that post was my refusal of statins from my doctor.

After reviewing my lipid panel, my doctor said I needed statins because my cholesterol was high, especially my LDL-C. He believed this increased my risk of cardiovascular disease (CVD).

He assured me, “Statins will lower my LDL-C and my risk of CVD.”

I subsequently refused his offer and gave him three reasons why.

I told him I believed that statins are often ineffective in lowering CVD risk, they’re dangerous, and I don’t need them.

Further, I explained that basing my CVD risk primarily on LDL-C levels was not in accordance with current scientific research.

Ooooh… I got such a look.

Doctors don’t like being told they’re wrong. Also, look at it this way. If I’m right, then I really am saying that my MD was violating one of his basic bioethical principles: “First Do No Harm.”

My doctor decided not to argue the point with me. That was wise as I was much more informed on statin use than he was.

In this post, I’ll show you why my doctor was wrong to offer me statins. I’ll also present some ways for optimizing your cholesterol levels.

Remember, these drugs are not harmless. They come with the potential for severe adverse reactions.

If you’re on statins or your doctor wants to put you on them, consider this information carefully. Then discuss it with your doctor. It’ll make you a well-informed patient.

Mainstream Medicine’s Criteria For Statin Therapy

Most mainstream physicians evaluate a patient’s need for statin therapy in accordance with the patient’s risk for cardiovascular disease (CVD) as indicated by his or her cholesterol numbers.

For example, the American College of Cardiology (ACC) and the American Heart Association (AHA) define a high-risk individual as one who has:

1. A history of CVD or a history of diabetes
2. Or an LDL level over 190 mg/dl
3. Or an LDL level of 70 to 189 mg/dL, without clinical CVD or diabetes and an estimated 10-year CVD risk > 7.5% (you can find your 10-year CVD risk according to the ACC here).  

If the nation’s doctors strictly observed these guidelines, then 80% of individuals over 65 years old and 44% of people between the ages of 40 to 64 in the United States would be on statins.

Currently, there are about 46 million people on statins. That number would jump to more than 70 million if the recommendations of the ACC and AHA were followed.

A Closer Look At The ACC/AHA Guidelines

If you look closely at the criteria for statin therapy, you’ll notice that criterion 2 and 3 appear to be primarily based on LDL-C levels.

That means that millions of asymptomatic individuals are considered to be at a high risk for CVD simply because they have an LDL-C level above what the ACC/AHA considers normal.  

Let’s take a look at the practical implications of these guidelines by examining my cholesterol levels.

My Lipid Panel

These are my cholesterol levels:

Total cholesterol (TC): 252 (normal range 0-200)

Triglycerides: 91 (normal range 30-200)

HDL cholesterol: 51 (normal range 40-60)

LDL-C cholesterol: 202 (normal range 0-130)

These results are all in mg/dl units.

As you can see, my TC and LDL are high. Those values were a signal to my doctor that I needed to be on statins.

Even though I have neither diabetes nor CVD, my LDL-C level is over 190 so I’m considered at high-risk for CVD. According to the ACA/AHA that makes me a good candidate for statin therapy.

However, consider this. If I reduce my LDL-C to 189 by natural means (diet), would I still be a candidate for statins? How about if I brought it down to 150?

Estimated 10-year CVD Risk

Even if I were to bring my LDL-C level down to the above numbers, I might still be a candidate for statins. Here’s why.

Since my LDL-C was over 70, my doctor would calculate my 10-year CVD risk. If it was > 7.5%, he would immediately recognize that I fulfilled category 3 of the ACC/AHA guidelines for statins.

By the way, my 10-year risk was over 7.5% even though the only risk factors I had were perhaps my age (60) and a high LDL-C and TC.

However, do you see the major problem with this risk calculation?

Two data points required in the calculation are your TC and LDL-C levels. This means that high TC and LDL-C are already presupposed to be risk factors.

But if they’re not, then the calculation for your 10-year risk determination is worthless.

So, the important question remains: is an LDL-C of greater than 190 mg/dl always an indicator of high risk for CVD?

Does my LDL-C number of 202 make me a good candidate for statin therapy? Yes or no? I say no.

Let’s begin by debunking the “cholesterol-heart disease” myth. One of my high numbers was total cholesterol.

Total Cholesterol Levels Aren’t a Good Indicator Of Heart Disease Risk

For years, we were warned that consuming foods high in cholesterol would eventually give us heart disease. So we refrained from eating foods like eggs and red meat.

However, the “cholesterol-heart disease” theory, perpetrated by the AHA, was debunked years ago.

Today, it’s acknowledged that total cholesterol levels tell us nothing about our overall risk of heart disease risk. That’s why the ACC/AHA no longer use it in their guidelines.

The only caveat here would be if an individual had a condition called familial hypercholesterolemia.

For the general population, though, several important studies have shown no association between heart disease and cholesterol. See here and here.

Watch below as in about one minute Dr. Malcolm Kendrick destroys the cholesterol-heart disease hypothesis.

Low Cholesterol Could Be Unhealthy

Cholesterol is vital to our existence. It’s a necessary component of cell membranes, a precursor for many hormones, necessary for our body’s use of vitamin D, and important in neurologic and digestive functions.

Since we don’t know exactly how much cholesterol is needed for these processes, lowering cholesterol too drastically could cause unintended negative health consequences.

Dr. Diamond in the Expert Review report noted that,

“there is a well-established role of viruses in cancer development, and it is well-known that reduced levels of cholesterol are associated with a greater incidence of viral infection and cancer…”

Remember that statins lower total cholesterol levels. This could be a reason for the increased cancer risk associated with statins.

Taking it a step further, Zoe Harcombe has done an excellent job showing that lower cholesterol levels are in fact associated with a higher mortality rate.

Okay, so it appears that my total cholesterol of 252 is not necessarily a risk factor.

Now let’s take a look at LDL-C.

What Is LDL?

You’ve probably heard LDL-C called the “bad cholesterol”. It’s termed that because at high levels it’s been associated with atherosclerosis and heart disease.

However, LDL-C is not cholesterol at all. It’s a low-density lipoprotein (LDL) that is responsible for carrying lipids, including cholesterol and triglycerides, around your body.

You’ve probably noticed by now I’ve abbreviated LDL as LDL-C.

This is because a standard lipid panel blood test doesn’t directly measure your LDL. Your LDL is calculated by using total cholesterol, HDL, and triglycerides.

Therefore, LDL-C is basically an estimate of your LDL level.

However, many researchers believe this estimated version of LDL is not the best way to assess CVD risk. They suggest a better way of evaluating risk is by considering the number and size of LDL particles.

LDL Particle Number

LDL-C is actually a measurement of the cholesterol mass within LDL-particles. Let me illustrate what this means.

LDL particles traveling in your bloodstream are analogous to cars with passengers traveling down a highway.

Cholesterol and triglycerides (as well as other fats) are passengers on the LDL molecule.

LDL-C is an estimate of the number of cholesterol passengers in the LDL particle.

At one time, researchers thought it was the cholesterol concentration in the LDL particle that was the driver in CVD.

Today, however, researchers believe that it’s the number of cars on the road, not the number of passengers that is the problem.

In other words, it’s the number of LDL particles in the blood that drives CVD not the amount of cholesterol in an individual particle (LDL-P).

Often an abnormally high LDL-C will reflect high LDL-P values. This is probably why a high LDL-C is associated with CVD risk. However, frequently the opposite is true.

Discordance

In many individuals, LDL-C and LDL-P are discordant. That means their LDL-C and LDL-P levels are not in agreement.

In fact, one study showed that 30 – 40% of individuals with low or normal LDL-C may have elevated LDL-P.

That means that even while their LDL-C level indicates a low risk for CVD, their LDL-P value indicates that they actually have a high risk for CVD and of also developing metabolic syndrome.

Now, discordance can also work the other way. If a person has a high LDL-C and a low LDL-P, then that person is at a lower risk for CVD.

Unfortunately, since that person’s doctor is only concerned with LDL-C, the doctor would still want to put their patient on a statin.

An important recent study, which included 68,000 individuals, showed that high LDL levels were not associated with increased death in people over 60. In fact, the study showed that elderly people with high LDL-C live as long or longer than those with low LDL-C.

Therefore, LDL particle size is another factor to consider in CVD risk.

LDL-P Size

LDL particles exist in different sizes. There is a small dense particle and a larger buoyant particle.

Studies have shown that the smaller, denser LDL-P are the ones implicated in CHD. See here, here and here.

Another study showed that small LDL-P appeared to penetrate the coronary artery walls 1.7 times more than large LDL particles.

Research is also finding that small LDL particles are not the sole driver of CVD.

Inflammation Is Another Driver Of CVD

There is good evidence that there’s an inflammatory process behind the development of CVD, and that this inflammation exists prior to the formation of the atherosclerotic plaque.

It seems that LDL particles must be oxidized before they adhere to the coronary arteries. For a good discussion on this, see here.

Insulin resistance, type 2 diabetes, and metabolic syndrome produce highly inflammatory states within the human body which could be a participating factor in CVD.

So, as we’ve seen, simply looking at LDL in isolation will not give you a good picture of how cholesterol is affecting your body.

If you want a true picture of your CVD risk in terms of LDL, you have to find out what your particle number and size is. These lab tests could be expensive though.

A Better Way to Assess Your Heart Disease Risk In Terms Of Cholesterol

While total cholesterol and LDL-C levels in isolation tell us very little about heart disease risk, there is a better way to predict risk.

The ratio of triglycerides to high-density lipoprotein has been shown to be a good predictor of heart disease. See here and here.

Triglycerides (TG) are a type of fat found in your blood. High-density lipoprotein (HDL) is considered your “good cholesterol”.

This study found that a TG/HDL ratio above 4 is an extremely powerful predictor of developing CVD.

Interestingly the predictive value of TG/HDL ratio was the same for men and women.

What’s The Ideal TG/HDL Ratio?

A TG/HDL ratio below 2.0 is considered ideal. A ratio above 4 is considered too high, and a ratio above 6 is considered extremely high. Note that these values are U.S. measurements. In other parts of the world, a different measuring system is used.

Remember that high TG/HDL numbers are usually found in people with type 2 diabetes and metabolic syndrome.

My TG was 91 and my HDL was 51. So my TG/HDL ratio is 1.78. According to this indicator, I’m at risk a low for CVD even though my total cholesterol and LDL were elevated.

The Total Cholesterol/HDL Ratio 

Another ratio to determine heart disease risk is the TC/HDL ratio. It’s an older means of assessing risk, but some doctors still use it.

Health.Harvard.edu, relying on the 1948 Framingham Heart Study, states that,

A ratio of 5 signifies average risk for heart disease; 3.4, about half the average risk; and 9.6, about double the average risk. Women tend to have higher HDL levels, so for them, a ratio of 4.4 signifies average risk; 3.3 is about half the average; and 7, about double.

However, the Mayo Clinic suggests that this ratio should be closer to 3.5.

If the Mayo Clinic is correct, then my TC/HDL ratio (4.9) is a little high. This has prompted me to try and raise my HDL (good cholesterol) level.

In order to do this, I’ll try to keep my carb intake below 30 grams/day and add in more intermittent fasting.

How To Optimize Your Triglyceride/HDL Cholesterol Ratio

It’s possible to optimize your TG/HDL without taking statins. I mentioned before that insulin resistance, type 2 diabetes, and metabolic syndrome (including obesity) all contribute to lipid and cholesterol abnormalities.

Correcting these risk factors is essential to regaining a good TG/HDL ratio.

The following is the strategy I’m using to optimize my TG/HDL ratio.

1. Lose weight. Even modest weight loss can lower triglyceride levels. I’ve lost about 25 pounds and shed a good deal of excess body fat.
2. Limit intake of sugar and fructose (especially high fructose corn syrup).
3. Avoid a low-fat, high-carbohydrate diet. Mainstream medicine tells us that diets high in fat, especially saturated fats increase the risk of heart disease. This is simply not true. See here and here. See my post on saturated fats here.
4. Follow a low-carbohydrate, healthy-fat diet (LCHF). I’ve been on a very low carbohydrate diet (<50 grams, often <30 grams/day) for about 10 months. Recent studies show that an LCHF diet is beneficial for improving TG/HDL ratios as well as other biomarkers. See here and here. See my post on why LCHF diets work for weight loss.
5. Consuming Omega-3 fatty acids like those found in fish oil. They have long been recognized for their ability to lower triglyceride oil. See here and here. I get my fish oil by eating salmon and sardines at least once a week.
6. Exercise often. See here and here.

That’s a wrap for this week. What’s your take on statins? We’d love to hear from you.

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The post My Cholesterol Level Part 2: Examining My Need For Statins appeared first on The Progressing Pilgrim.

I’ve now been on a low-carbohydrate healthy-fat (LCHF) diet for about nine months.

Outwardly, the results have been amazing. I’ve lost about 25 pounds (currently 168 lbs.), my BMI is 23.43, and my waistline is down to 35”. Also, my energy levels and weightlifting totals have not suffered.

However, I wanted to know how my LCHF diet was affecting my body on the inside. So I decided to see my M.D. for some baseline blood tests. 

The tests I was most curious about were my cholesterol levels, especially my LDL-C.

Make no mistake about it.  A LCHF diet is a high fat diet. My diet is composed of about 70% fat from healthy sources like extra-virgin olive oil, avocados, pastured butter, organic coconut oil, wild salmon, aged cheese, and grass fed meat.

This type of diet, according to the American Heart Association, could raise my cholesterol levels and put me at a high risk for cardiac disease.

Even though I believe the AHA to be wrong in their assessment of fat, I was still eager to see how a LCHF diet affected my cholesterol.

My Doctor Reviews My Cholesterol Numbers

As my M.D. reviewed my numbers, I noticed his eyebrows starting to rise slightly. This was followed by a very concerned sounding, “Your cholesterol numbers are a little high.”

Before he could give me my numbers, I responded, “Is my LDL high?” He nodded.

Prior to my test, I had a feeling some of my lipid levels might be high. Often when individuals go on a LCHF diet total cholesterol and LDL can become elevated.

These are my numbers in MG/Dl units:

Total cholesterol (TC): 252 (normal range 0-200)

Triglycerides: 91 (normal range 30-200)

HDL cholesterol: 51 (normal range 40-60)

LDL cholesterol: 202 (normal range 0-130)

As you can see, my TC and LDL levels are high.

My doctor proceeded to preach a sermon on the dangers of high cholesterol. His main point was that high cholesterol can cause heart disease.

I knew what the climax of the sermon would be so before he could mention the”S” word, I stopped him right in his tracks.

I Reject Statin Therapy

“Don’t even say the word statin.” That was my response to my M.D.’s sermon of gloom and doom.

He immediately looked stunned. I’m probably one of the few patients who has ever rejected his advice to take statins.

He quickly recovered his composure and summoned one last warning, “But you’re at risk for heart disease.”

Slowly I explained to him that I don’t need statins because current research shows that when my LDL and TC numbers are considered in context with my other lipid levels (which are good), I’m not at a high risk for cardiovascular disease (CVD).

Obviously, he realized he was dealing with an informed patient so he didn’t pursue the issue. He simply said, “Let’s review the matter in three months.”

In my next post, I’ll explain why my cholesterol numbers don’t indicate I’m at risk for CVD.

Today, though, I’d like to explore why my doctor was so quick to suggest I go on statins. 

Why Do Doctors Rush To Prescribe Statins?

Here’s the thing. Whenever mainstream medical doctors see high cholesterol levels and an LDL level over 190, their first reaction is to suggest that their patients take a statin drug. Statins lower cholesterol by blocking the enzyme in your liver that is responsible for making cholesterol.

This practice appears to be motivated by recommendations from the American College of Cardiology (ACC) and the American Heart Association (AHA).

These recommendations have resulted in millions of Americans taking statins and perhaps millions taking them needlessly.

We’ve Become A Statin Nation

As of 2012, 28 percent of Americans over the age of 40 are taking a statin drug. According to the 2010 census, there are about 163.5 million people over the age of 44.

That would mean that there are at least 45.6 million people taking statins.

While that number seems outrageously high, the Center for Disease Control (CDC) in 2015 stated that even more Americans should be on cholesterol-lowering drugs.

They believe that 44 percent of people ages 40 to 64 along with 80 percent of those 65 and older should be on statins. Did you get that? Eighty percent of everyone over 65 should be on a statin!

That’s a staggering number. To say that we’re becoming a statin nation isn’t an understatement. We are a statin nation.

The CDC’s reason for the widespread use of statins is that they believe a huge percentage of the American population is at risk for cardiovascular disease (CVD), including the possibility of a heart attack.

Are the CDC, the ACC, and the AHA, however, correct in their assessment of this risk?

How Does Mainstream Medicine Determine Who Needs Statins?

The American College of Cardiology/American Heart Association suggest that individuals be treated with statins if they are at a high risk for CVD.

They define high risk people as those who:

1. Have a history of CVD, or a history of diabetes,
2. Or an LDL level over 190 mg/dl
3. Or an LDL level of 70 to 189 mg/dL, without clinical CVD or diabetes and an estimated 10-year CVD risk of 7.5% (you can find your 10-year CVD risk according to the ACC here).  

It appears that these guidelines are what prompted the CDC to recommend that over 60% of all Americans over 45 be placed on statin therapy.

Before I explore whether the above guidelines are indeed indicative of a higher risk of CVD I think it’s vital to first consider the efficacy and safety of statin use.

It doesn’t matter what the guidelines are if the cure creates more harm than good.

Are Statins Really Effective And Safe?

Statins have often been called a miracle drug. This is because it’s claimed that they lower an individual’s risk of a first-time heart attack and reduce that person’s chance of developing CVD, while at the same time possessing no significant adverse side effects.

But Are those claims true?

Not according to a 2015 report in the journal of Expert Review of Clinical Pharmacology authored by David M. Diamond and Uffe Ravnskov. Diamond and Ravnskov examined several clinical trials that reportedly confirmed the effectiveness and safety of statins.

After an in-depth review of the literature, they found that while,

…statins are effective at reducing cholesterol levels, they have failed to substantially improve cardiovascular outcomes.

In other words, the health claims that drug companies make about statins are false.

How Drug Companies Manipulate Statistics

Diamond and Ravnskov show that statin advocates often use a statistical sleight of hand in order to make statins appear to be successful in reducing heart disease.

This is done by reporting the relative risk reduction (RRR) of a particular statin, rather than its absolute risk reduction (ARR) .

Let me illustrate the difference.  Suppose we want to do a 5-year trial to see if a statin can prevent heart disease. In this trial, we include 2,000 healthy, middle-aged men. We then administer a statin to half the participants and to the other half we give them a placebo.

At the end of our hypothetical trial, we find that 2% of the placebo-treated men (a normal occurrence in most trials) and 1% of the statin-treated men suffered a heart attack. We can thus conclude that statin treatment has benefitted 1% of the treated participants. This is the ARR.

So we could construct a headline that reads,

“News Alert: New Miracle Drug Reduces The Risk Of CVD By 1% In At Risk Individuals!”

Now, that’s not a very impressive headline. Would it convince you to take a statin drug?

Let’s, however take a look at relative risk reduction. RRR is determined by dividing the ARR by the control event rate (the placebo group).

For example, the ARR is 1 and the control group contains 2 people who suffered a heart attack. To find the RRR we divide 1 by two and come up with 50%.

We can now write a new headline that says,

“New Flash: New Miracle Drug Cuts CVD Risk By 50%!”

Now that’s a lot more impressive sounding, isn’t it? That kind of headline could generate a lot of sales for statin drug manufacturers.

Interpreting Statin Research Correctly

The Expert Review report analyzed 3 major statin drug trials. These trials included over 48,000 participants.

The results of the trials led researchers to ecstatically declare that statins can significantly reduce the chance of a heart attack and CVD.

The makers of the popular statin Lipitor even advertised that it could lower the risk of heart attack in at-risk populations by 36 percent.

However, Diamond and Ravnskov discovered that when ARR data was used instead of RRR data, the risk of a heart attack was reduced by only 1.1 percent.

Notice the caveat at the bottom of the Lipitor advertisement.

In the trial concerning the statin Crestor, “public and healthcare workers were informed of a 54 percent reduction in heart attacks, when the actual effect in reduction of coronary events was less than 1 percentage point…”

Overall, Diamond and Ravnskov found that when the three major statin trials were analyzed from the perspective of ARR, only a 1-2 percent reduction of heart attack or CVD risk was achieved.

So when your doctor suggests you take statins because your cholesterol is a little high, he should remind you that your chance to avoid a nonfatal heart attack during the next 2 years is about 97 percent without treatment, but you can increase it to about 98 percent by taking a statin every day.

Not very impressive, is it?

Oh, and he should also remind you that with that 1 percent benefit, you might suffer some severe adverse reactions.

If you want to see Dr. Diamond explain his findings on statins, click here.

Adverse Reactions From Statins

While many doctors downplay the adverse reactions of statins, this 2008 review in the American Journal of Cardiovascular Drugs analyzed almost 900 studies and found that adverse effects from statin drugs are “neither vanishingly rare nor of trivial impact.”

Statin therapy has been associated with increased rates of the following disorders:

• Musculoskeletal Disorders
• Cancer
• Cognitive Impairment
• Type 2 Diabetes
• Liver Enzyme Abnormalities

The American College of Cardiology in a 2016 report does admit that there are adverse effects associated with statin therapy. However, they say the occurrences are rare.

Yet, in the above-mentioned Expert Review report, the authors show that the way statin researchers measure the risk of adverse effects is also flawed.

Diamond and Ravnskov argue that when it comes to assessing the adverse effects of statins, researchers should focus on relative risk instead of absolute risk. The major statin trials primarily assessed absolute risk.

The two authors found that ignoring the relative risk of adverse effects, “minimizes the appearance of their magnitudes”, and adverse effects are “either ignored or explained away as chance occurrences.”

Diamond and Ravnskov ultimately conclude,

The reality, however, is that statins actually produce only small beneficial effects on CVD outcomes, and their adverse effects are far more substantial than is generally known.

Statins Might Also Cause Atherosclerosis

Atherosclerosis is the formation of plaques within the coronary arteries. These plaques can break off, block the artery, and cause a heart attack.

A recent report in the journal Expert Review of Clinical Pharmacology has suggested that statin use might actually cause atherosclerosis.

The authors suggest that statins may cause coronary calcification by:

• Damaging heart muscle mitochondria
• Depleting coenzyme Q10
• Inhibiting the synthesis of vitamin K2
• Inhibiting the biosynthesis of selenium containing proteins

As we have seen, statins may not be the wonder drugs they’re reported to be. While they do reduce cholesterol they don’t seem to significantly improve an individuals risk of CVD and are often accompanied by some serious adverse side effects.

So, with my total cholesterol and LDL being high, should I have assented to my doctors advice and accepted a prescription for a statin?

That decision ultimately depends on whether my cholesterol numbers actually put me at risk for heart disease.

Next week, I’ll take a look at that risk. I think you’ll see that my initial reaction to statins was the right one.

That’s it for this week. I’d love to hear what you have to say.

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The post My Cholesterol Levels Part 1: Why I Rejected Statins appeared first on The Progressing Pilgrim.