As I’m sure many of you know, a large new study concluded that saturated fat doesn’t cause heart disease. Here’s a quote from one of the many media articles about the study:
Many of us have long been told that saturated fat, the type found in meat, butter and cheese, causes heart disease. But a large and exhaustive new analysis by a team of international scientists found no evidence that eating saturated fat increased heart attacks and other cardiac events.
For decades, health officials have urged the public to avoid saturated fat as much as possible, saying it should be replaced with the unsaturated fats in foods like nuts, fish, seeds and vegetable oils.
But the new research, published on Monday in the journal Annals of Internal Medicine, did not find that people who ate higher levels of saturated fat had more heart disease than those who ate less. Nor did it find less disease in those eating higher amounts of unsaturated fat, including monounsaturated fat like olive oil or polyunsaturated fat like corn oil.
This ought to drive a stake through the heart of the Lipid Hypothesis, but it won’t. Here’s part of a blog post by Dr. Malcolm Kendrick, offering his prediction:
You see, the entire edifice of the cholesterol hypothesis is held together by two links in a chain. Link one is that saturated fat consumption raises cholesterol levels. Link two is that raised cholesterol levels then cause heart disease.
This is the cholesterol hypothesis, or the lipid hypothesis, and it has driven medical thinking for the last sixty years.
I have had it painstakingly explained to me, by very clever people, exactly how saturated fat raises cholesterol levels. Indeed, you will find ‘evidence’ for this almost universally accepted fact in literally thousands of clinical studies.
Okay, let us accept that eating saturated fat does raise cholesterol levels. However, if consumption of saturated fat does not increase the rate of heart disease then …. Then raised cholesterol levels can have nothing whatsoever to do with causing heart disease. Just keep chasing the implications of that statement around in your head for a while.
So what happens now? We now have a cholesterol/lipid hypothesis that just had its head blown off. Yet, it still continues to wander about, unaware that it is actually dead… I suspect it will continue to rampage about, stomping on puny humans for many years, before it finally keels over and admits that it is dead.
The cholesterol hypothesis is not only blissfully unaware of its demise, its proponents are pushing harder than ever to beat down everyone’s cholesterol levels. Take a look at the latest news on guidelines for prescribing statins:
The new American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for the treatment of cholesterol would increase the number of individuals eligible for statin therapy by nearly 13 million people, an increase that is largely driven by older patients and treating individuals without cardiovascular disease, according to a new analysis.
Awesome. So we’d be giving statins to more older people (the group least likely to benefit from statins) and people who don’t have heart disease (the other group least likely to benefit from statins). Makes perfect sense. I don’t have cancer, but I’m considering signing up for chemotherapy just in case.
Among older adults, those aged 60 to 75 years old, 87.4% of men would now be eligible for the lipid-lowering medication, which is up from one-third under the old Adult Treatment Panel (ATP) III guidelines. For women of the same age, the percentage of those now eligible for statins would increase from 21.2% under ATP III to 53.6% with the new 2013 clinical guidelines.
Headline from the future: Doctors baffled by sharp rise in Alzheimer’s, arthritis among elderly.
The increase, say investigators, is the result of more patients being eligible based on their 10-year risk of cardiovascular disease.
Yeah, that must be it. It couldn’t be the result of a desire to sell more statins.
The new guidelines identify four groups of primary- and secondary-prevention patients for physicians to focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate “intensity” of statin therapy in achieving relative reductions in LDL cholesterol.
These four groups include individuals with clinical atherosclerotic cardiovascular disease, individuals with LDL-cholesterol levels >190 mg/dL, diabetic patients without cardiovascular disease aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL, and those without evidence of cardiovascular disease, an LDL cholesterol level 70–189 mg/dL, and a 10-year risk of atherosclerotic cardiovascular disease >7.5%.
In other words, resistance is futile. Almost everyone needs to take statins at some point. Go get yours before the Christmas rush.
Let’s suppose that statins do prevent heart attacks in some people … say, middle-aged men already known to have heart disease. Does that make statins the best possible treatment? I hardly think so. Take a look of part of an article reporting on a comparison of statins vs. fish oil:
A clinical trial reported in the Archives of Internal Medicine compared people who took statin drugs with those who just took fish oil capsules. Both these groups were compared to a control group that took a placebo. The statin group decreased mortality by 10% over the placebo group; however, the fish oil group decreased mortality by 23% over the placebo group. In other words, the participants who took the fish oil capsules had over twice the health benefit of those who took the statin drugs.
Hmmm, statins or fish oil … tough choice. Statins cause muscle pain, joint pain, mitochondrial damage, liver damage and cognitive impairment. By contrast, here’s what WebMD has to say about omega-3 fatty acids, the type of fats found in fish oil:
Hundreds of studies suggest that omega-3s may provide some benefits to a wide range of diseases: cancer, asthma, depression, cardiovascular disease, ADHD, and autoimmune diseases, such as rheumatoid arthritis.
And I’m guessing fish oil probably won’t turn you stupid and make your joints hurt. The trouble is, nobody’s going to rake in $30 billion per year from fish-oil tablets or wild-caught salmon. As far as I know, you can’t patent a fish — although it wouldn’t surprise me to learn Monsanto has tried patenting a laboratory salmon that can’t reproduce.
The cholesterol hypothesis has indeed had its head blown off, but I agree with Dr. Kendrick: it will continue to stomp us tiny humans for years, or at least until nobody’s making a hefty profit selling cholesterol-lowering drugs.