Does Cholesterol Really Matter?

by Julian Whitaker, M.D.

I'd like to shine the spotlight on one of medicine's sacred cows- the belief that lowering cholesterol with drugs protects against heart attacks and premature death. Our obsession with cholesterol began in the 1950s when studies linked high consumption of animal fat with high rates of heart disease. This opened the door for clinical trials that laid the foundation of a new paradigm: the cholesterol theory of cardiovascular disease.

This theory has had profound ramifications. It changed the way we eat (fats bad, carbohydrates good) and contributed to our problems with obesity and diabetes. It wormed its way into "clinical practice guidelines"- cholesterol management has become a "standard of care" that doctors are expected to follow. It spawned the invasive heart surgery industry, based on the presumption that cholesterol-laden blockages must be bypassed or propped open. And it led to the creation of the best-selling class of medications in history: cholesterol-lowering statin drugs, which generate more than $15 billion in worldwide sales every year.

But it's all a house of cards. No matter what you've been led to believe, a high cholesterol level is not a reliable sign of an impending heart attack. In fact, growing numbers of experts question whether cholesterol matters at all. As for statin drugs, for most of the 40-plus million Americans recommended to take them for the rest of their lives, they're an ineffective, expensive, side effect- riddled fraud.

Statin-Free Zone

When a patient taking Lipitor, Zocor, or another statin drug comes to Whitaker Wellness, we discontinue it at once. "But my cholesterol level is 240." "My doctor told me I'll have a heart attack if I don't take this drug."My father died of heart disease, so I have to take it." I've heard all these justifications and more, and I still recommend that my patients get off statins. Here's why.

First, they're not very effective. These drugs do lower cholesterol, but so what? We're not treating lab numbers. We're treating patients, and the ultimate goal in cholesterol management is to reduce risk of cardiovascular disease. Except for a very limited number of people, there is absolutely no evidence that statins protect against heart attack or premature death.

Are you over age 65? Not a single study suggests you'll receive any benefits, even if your cholesterol goes down substantially. A woman of any age? Same story. A man younger than 65 who has never had a heart attack? Ditto, no help at all. For middle-aged men who have had a heart attack, statins may lower risk of a repeat heart attack, but that's the extent of it.

I know this is hard to buy in light of the multiple drug advertisements and glowing endorsements from doctors. But keep in mind that pharmaceutical companies do a superb job of pulling the wool over the eyes of consumers and physicians alike by withholding unfavorable study results and making false, misleading, and often deceptive claims.

A Statistic We Can Understand

That's why I want to step around confusing statistics and tell you about an easy-to-understand measure that you'll never hear about in drug ads. It's called "number needed to treat," or NNT, and it describes the number of patients who would need to be treated with a medical therapy in order to prevent one bad outcome. Experts consider an NNT over 50 to be "worse than a lottery ticket."

Lipitor ads claim that it reduces risk of heart attack by 36 percent. Sounds pretty good until you look at the fine print, do the math (which John Carey did in a great article in Business Week), and figure out that the drug's NNT is 100. This means that 100 people must be treated with Lipitor in order for just one heart attack to be prevented. The other 99 people taking the drug receive no benefit.

To put this into perspective, the NNT of antibiotics for treating H. pylori, the underlying cause of stomach ulcers, is 1.1. These drugs knock out the bacteria in 10 out of 11 people who take it, making them a reliable, cost-effective therapy. At the other end of the spectrum are statins, which as a class have an NNT of 250, 500, or higher depending on the study you look at. What a deal for drugs that can cost more than a thousand bucks a year and are almost guaranteed to cause problems.

Goodbye Drugs, So Long Symptoms

Statins lower cholesterol by suppressing the activity of an enzyme in the liver involved in the production of cholesterol. But this enzyme has multiple functions, including the synthesis of coenzyme Q10. CoQ10 is a key player in the metabolic processes that energize our cells. No wonder statin users often suffer from fatigue, muscle pain and weakness, and even heart failure- the cells are simply running out of juice.

The second most frequent adverse effects of statins are problems with memory, mood, suicidal behavior, and neurological issues. Other common complaints include sexual dysfunction, and liver and digestive problems. Symptoms range from minor (achiness, forgetfulness) to serious (complete but temporary amnesia, permanent memory loss) to lethal (congestive heart failure, rhabdomyolysis or complete muscle breakdown). One statin drug, Baycol, was taken off the market a few years ago after it caused dozens of deaths from rhabdomyolysis. Several studies have also linked statin drugs with an increased risk of cancer.

Because physicians rarely warn of these side effects, few patients suspect their drugs may be the reason they begin feeling bad- and it's often a revelation when they put two and two together. Simply discontinuing these medications can result in tremendous improvements in health and well-being. Texas cardiologist Peter Langsjoen, MD, published a study showing that when symptomatic patients got off their statins and started taking 240 mg of CoQ10 per day, they had significant decreases in fatigue, myalgias (muscle aches), dyspnea (shortness of breath), memory loss, and/or peripheral neuropathy.

Not a Drug But a Program

As you can see, we need to shift away from this myopic focus on statin drugs and lowering cholesterol, and take a more holistic view. Folks, you don't need statins- you need a program that addresses all the known risk factors for heart attack, stroke, and other cardiovascular disorders.

Inflammation, not high cholesterol, is the primary cause of heart disease. Harvard researchers have discovered that a high blood level of C-reactive protein, a marker of inflammation, is more predictive of heart disease than cholesterol.

In short, do what you can to manage your cholesterol, but don't worry about it if your level is particularly stubborn. The average cholesterol of people who have heart disease isn't much higher than the level of those who don't. If high cholesterol runs in your family, concentrate on what you can control, and remember, numbers aren't everything.

Yoga May Help Seasonal Affective Disorder

If you feel foggy, fatigued and depressed during the winter months, you may be among the 10 to 20 percent of adults who experience mild seasonal affective disorder (SAD). Symptoms include anxiety, weight gain, oversleeping, and social withdrawal. Although SAD is linked to lack of sunlight, in addition to supplementing with Vitamin D, try yoga. Yoga poses involving the crown chakra, or the top of the head, may stimulate the pineal gland, which produces the feel-good hormones serotonin and melatonin, and helps regulate circadian and seasonal rhythms.

Mediterranean Diet May Lower Risk of Developing Thinking and Memory Problems

A Mediterranean diet may help people avoid the small areas of brain damage that can lead to problems with thinking and memory, according to a study released today that will be presented at the American Academy of Neurology's 62nd Annual Meeting in Toronto April 10 to April 17, 2010. The study found that people who ate a Mediterranean-like diet were less likely to have brain infarcts, or small areas of dead tissue linked to thinking problems.

The Mediterranean diet includes high intake of vegetables, legumes, fruits, fish, whole grains, and monounsaturated fatty acids such as olive oil; low intake of saturated fatty acids, dairy products, meat and poultry; and mild to moderate amounts of alcohol.

For the study, researchers assessed the diets of 712 people in New York and divided them into three groups based on how closely they were following the Mediterranean diet. Then they conducted MRI brain scans an average of six years later. A total of 238 people had at least one area of brain damage. Those who were most closely following a Mediterranean-like diet were 36 percent less likely to have areas of brain damage than those who were least following the diet. Those moderately following the diet were 21 percent less likely to have brain damage than the lowest group.

The relationship between this type of brain damage and the Mediterranean diet was comparable with that of high blood pressure. In other words, not eating a Mediterranean-like diet had about the same effect on the brain as having high blood pressure.

Previous research by Scarmeas and his colleagues showed that a Mediterranean-like diet may be associated with a lower risk of Alzheimer's disease and may lengthen survival in people with Alzheimer's disease. According to the present study, these associations may be partially explained by fewer brain infarcts.

Hostility Associated with Visceral Fat in Middle-Aged Women

In a study conducted at the Yale University School of Medicine and recently published in the Journal of Psychosomatic Medicine, researchers found that higher levels of hostility were associated with a greater amount of visceral fat in both African-American and white middle-aged women. This association remained significant after further adjustments for education and multiple coronary heart disease risk factors. Hostility was not associated with subcutaneous fat. They concluded that hostility may affect risk for coronary heart disease in women via the accumulation of visceral fat.

I think these findings are very significant and point once again to the link between stress (as hostility is a toxic emotion) and abdominal fat. Visceral fat, which hugs the internal organs, such as the kidneys, liver and pancreas, is considered to be more dangerous that subcutaneous fat, which is deposited just below the skin. My hunch is that hostility kept inside is even more dangerous than hostility that is outwardly expressed.

Maintaining Healthy Bones

For many years I have been following the work of Annemarie Colbin, Ph.D., nutritional expert and author of the recent book, "The Whole Food Guide to Strong Bones." I recently received the following email from her:

"Fosamax and similar drugs interfere with bone metabolism, which in turn interferes with blood metabolism- preventing calcium and other minerals from being released into the blood to keep its ph steady. They make bones more brittle and contribute to heart palpitations."

To maintain strong bones, Annemarie recommends eating salad or greens every day (for the calcium and vitamin K), eating sufficient protein (for the collagen matrix), avoiding "low fat" anything, and eating enough butter or olive oil (to keep the fat-soluble vitamins in solution). Cook everything with stock or bone broth. If possible, eat bones-from sardines, soft shell crabs, and chew on chicken bones. This approach works very well, and it's fun, cheap and tasty.

For more information on Annemarie Colbin, go to www.foodandhealing.com.

Lower Depression Risk Linked to Mediterranean Diet

Eating a Mediterranean-style diet packed with fruits, vegetables,legumes, nuts, olive oil and fish is good for your heart. Now scientists are suggesting the diet may be good for your mental health, too.

A study of over 10,000 Spaniards followed for almost four and half years found that those who reported eating a healthy Mediterranean diet at the beginning of the study were about half as likely to develop depression than those who said they did not stick to the diet.

All of the participants were free of depression when they were recruited to the study, and each filled out a 136-item food frequency questionnaire when they joined. Based on their self-reported dietary habits, they were assigned a score between 0 and 9, with the highest score reflecting the closest adherence to a Mediterranean diet. Over time, those who had scored between 5 and 9 on the Mediterranean diet were 42 to 51 percent less likely to develop depression than those who scored between 0 and 2.

Many scientists are convinced that the same damaging inflammatory and metabolic processes involved in cardiovascular disease may also play a role in mental health. Both cardiovascular disease and depression share common mechanisms related to endothelium function and inflammation, said Dr. Miguel Angel Martinez-Gonzalez, professor of preventive medicine at University of Navarra in Pamplona, Spain, and senior author of the paper, published in the October issue of Archives of General Psychiatry.

The membranes of our neurons are composed of fat, so the quality of fat that you are eating definitely has an influence on the quality of the neuron membranes, and the body's synthesis of neurotransmitters is dependent on the vitamins you're eating, Dr. Martinez-Gonzalez added. We think those with lowest adherence to the Mediterranean dietary plan have a deficiency of essential nutrients.

The elements of the diet most closely linked to a lower risk of depression were fruits and nuts, legumes and a high ratio of monounsaturated to saturated fats.

Gratitude Exercise Reduces Depression

A York University psychology professor, Myriam Mongrain, Ph.D., found that listing five things a day that one is grateful for can reduce depression symptoms. They found that this simple exercise especially increased well-being amongst people who tended to focus on the negative aspects of their lives.