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.

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43 Responses to “Statins For Everyone!”
  1. Cary L says:

    The oft-repeated line from “Fat Head” seems most appropriate here … “Follow the money.” Methinks I’ll hold off on rushing out to buy my bulk order of statins for now.

  2. Nick S says:

    Is this the study? http://www.ncbi.nlm.nih.gov/pubmed/15824290

    It is persuasive by itself, but this meta-analysis (http://archinte.jamanetwork.com/article.aspx?articleid=1151420) casts some doubt, including a number of clinical studies that show no effect from fish oil any better than placebo.

    Slightly different subjects, mortality vs. secondary prevention, but I’ll grant that the evidence on fish oil may not be conclusive. I’d also wager the overall evidence for the benefits of fish oil is stronger than the evidence for the benefits of statins.

    • Boundless says:

      Looks like confounding to me. I haven’t dug too deeply, but it doesn’t look like either analysis controlled for type of diet. I would want to see results for low carb vs. “usual diet”.

      “Our meta-analysis showed insufficient evidence of a secondary preventive effect of omega-3 fatty acid supplements against overall cardiovascular events among patients with a history of cardiovascular disease.”

      Well, sure, given that the subjects were probably still on the diet that caused the CVD in the first place, or worse, on the LF diet that most clueless cardiac MDs prescribe.

      I’m of the opinion that “HF” is only marginally beneficial if one is not also “LC”. And that benefit is apt to just be appetite reduction.

  3. Ash Simmonds says:

    Insulin resistance is futile.

  4. Pierson says:

    Having first been prescribed statins as a health-conscious healthy, lean, and active 24-year old with ‘high cholesterol’ (TC: 256, LDL: 161), I’ll say that their change in recommendations is very refreshing. Seeing as how I’m now in the ‘appropriate’ age bracket for statin therapy once again, however, it’s fair to ask just how much these new recommendations are really helping. Really, as good as it is that fewer 20-somethings will have to go through the pushiness of a pill-happy worshipper of conventional wisdom, I can’t help but feel terrible for healthy middle-aged and elderly folks who will have to go through the same. Here’s hoping outreach and education wins out!

  5. Steve says:

    I have a bad shoulder that aches and flares up. I starting taking fish oil 20 years ago to “improve my lipid profile”. I didn’t notice the fish oil had greatly benefited my shoulder… took me a while to notice if I ran out of fish oil my shoulder got achy.

    At least for me marine oils seem to be a powerful anti-inflammatory agent. This ties in nicely with the inflammation hypothesis. In contrast, statins gave me joint aches

  6. Jean says:

    Once an idea has taken hold, especially if it becomes part of the education system and is then taught through out of date text books, it will be years and years before it ‘dies’. I was told the other day that I shouldn’t eat eggs because I will get high cholesterol and this was by a girl in her twenties!

    I was on a cruise ship and heard a young woman give her boyfriend an earful because he ordered hollandaise sauce “and it’s just egg yolks and butter! Do you want to have a heart attack before you turn 30?”

  7. Bruce B says:

    Great Summary as usual Tom. I always look forward to your take on these things. The talking heads at FOX News are in denial over this study. One of the doctors basically said the study might have found that there is no evidence that saturated fat causes deaths from heart disease but I believe saturated fat is bad for you so avoid it anyway.

    Yup, doctors who’ve been warning people away from saturated fat for decades are going to have a difficult time accepting that they’ve been handing out lousy advice.

  8. Linda says:

    Once again, thank you Tom, for taking your time to bring such info to the rest of us. Now, I’m going to get busy and send all this stuff to my opthamologist. By coincidence, I was in his office yesterday. I always take something to read, since, sometimes it’s a wait. By chance, I was reading “How Statin Drugs Really Reduce Cholesterol and Kill You One Cell at a Time.” My doc is always interested in what I’m reading and when he read the title, he kind of shuddered and said let’s don’t discuss that- I’m already on a statin. This is a 33 year old man, brilliant, in great health, runs marathons, no high blood pressure, no diabetes, etc. I immediately told him my experience with statins, which promptly made me almost crippled before I stopped taking them. My doc is a man who is really adamant that he not prescribe anything for a patient without intense research and being absolutely positive that it won’t cause any harm. Why would he just take a statin, because some uninformed doctor prescribed it? Rhetorical, I know. Anyway, he gave me his email address and promised to read what I sent. Today’s post will be at the top of the list. I plan to drop Dr. Kendrick’s book, “The Great Cholesterol Con,” by his office also. Thanks again for all you do!

    Kendrick’s book would be perfect.

  9. Grant says:

    A laboratory salmon that can’t reproduce (but with all of the benefits of wild salmon)? That would be AWESOME. No, seriously, it would be.

  10. Jill says:

    Tom, I wish you’d do a post on what questions to ask of scientific studies.

    Have seen your “Science for Smart People” -great viewing!- but I notice you introduce some secondary and tertiary considerations when discussing studies here.

    I’ll think on that one.

  11. TJ Huber says:

    I am a retired orthopedist (strong as an oxen and twice as smart) with little, if any, expertise in cardiology. I quit taking statins about 3 years ago. I didn’t like the mental fuzziness that came with it. I started taking fish oil about two and a half years ago and, lo and behold, my PVCs, an abnormal heart rhythm which had bothered me for over ten years, all but disappeared. Obviously, this is purely anecdotal, but I pass it on for whatever it’s worth.

    Case studies aren’t in the same league as RCTs, but we shouldn’t ignore them either.

  12. Bret says:

    That NYT blog article describing the study impressed me–it actually mentioned the large/fluffy vs small/dense LDL that nobody else ever seems to talk about. Of course, the author just had to quote Lichtenstein of the AHA repeating the opposite of what this study just demonstrated, but then slyly pointed out the source of her confirmation bias.

    A Fox News article by Dr. Manny Alvarez gave a similar rundown of the study, but then continued sounding the alarm about saturated fats, with no evidence whatsoever, concluding, “So don’t get confused: If you give in to a diet high in saturated fats, your internal plumbing will become clogged.”

    I think Dr. Kendrick is right. Despite being disarmed and dismantled by this new study, the Lipid Hypothesis has been bludgeoning the western world in the face for the last 40 years. I don’t think it’s going away any time real soon. Gary Taubes also predicted somewhere that the tide was already turning on sugar, and that it likely would on grains very soon, but that the paranoia surrounding saturated fat would endure for years, if not decades.

    I agree. Sat-fat hysteria has been around for two generations and will take awhile to go away.

  13. Elenor says:

    “Insulin resistance is futile.”

    and really really FRUSTRATING!

  14. Margot says:

    I really appreciate your humor and clarity on nutrition, but have to object to the caricature of Monsanto & GMOs.

    The idea that most GMOs cannot reproduce is a myth that just won’t die–the so-called “Terminator” gene developed by Delta and Pine Land has yet to be used in the development of any GMOs. If GMOs did contain the “Terminator” gene, there would be no reason for the contracts farmers who plant GMO seed sign promising not to save the seed and replant it.

    See: http://www.npr.org/blogs/thesalt/2012/10/18/163034053/top-five-myths-of-genetically-modified-seeds-busted

    You might also be interested in Dan Charles’ excellent history of the development of GMOs, Lords of the Harvest (Basic Books, 2001).

    Good to know, but apparently Monsanto is interested in the idea:

    http://www.viewingspace.com/genetics_culture/pages_genetics_culture/gc_w03/terminator_abc/terminator_seed.htm

    For the record, I don’t think we should label everything that’s GMO as harmful just because it’s GMO. We should label foods as harmful if they’re harmful.

    • Ed says:

      As a Libertarian, I do not and would not propose outlawing GMO’s. I most definitely do want mandatory labeling though. Just the facts, no opinions. I think we do have the right to know what we are eating and feeding our families. I’ll make up my own mind if I want to consume them or not.

      The current law that allows Monsanto and other GMO producers to sue farmers that have their crops contaminated by GMO’s even though they never planted or even want them is also wrong.

      In the case of contamination of an organic farmers crops, he has effectively been put out of business. It is Monsanto that should be held liable, not the other way around. And yes, liability for the harm you cause others is most definitely a tenet of Libertarianism.

      Absolutely. We libertarians take property rights seriously.

      • Bret says:

        I don’t agree with mandatory labeling. GMO labels are not going to stop people from buying those products any more than calorie labels get people to eat less, surgeon general warning labels get people to quit smoking/drinking, etc. A labeling mandaate would introduce new costs to producers that would be passed on to consumers. And then, the policy has to be enforced, which ultimately equates to more tax dollars going to the FDA & USDA regulatory enterprises. Ergo, we tax-paying consumers all fork over more money to multiple parties, all for a one-size-fits-all, ineffective label. Doesn’t sound appealing to me.

        We don’t need government screwing up yet another project. In reality, food companies that want to market products to health-conscious people will willingly label their food “GMO free.” Any company that does so under false pretenses is guilty of fraud and thus subject to suit by those defrauded.

  15. Matt says:

    Fish Oil does have one huge negative side effect. Burping after taking fish oil is pretty nasty. :)

    It beats mitochondrial damage and cognitive decline.

    • neilfeldman says:

      The biggest issue is that long chain poly-unsaturated fatty acids will depress the immune system. And fish oils are the longest.

      It seems the ideal is to maintain a ratio of 1:1 omega-6 to omega-3 fatty acids. That would imply cutting out all vegetable oils while eating more fatty fish and/or perhaps taking a very small amount of fish oil supplement – if any.

    • Steve says:

      Try krill and if that doesn’t work, enteric coated

  16. Jeff says:

    And now they are saying that there are 20 times more fish in the ocean than we originally thought.

    Yum, yum, all that Omega-3…

  17. “Yup, doctors who’ve been warning people away from saturated fat for decades are going to have a difficult time accepting that they’ve been handing out lousy advice.”

    My LCHF mentor Andy Lopez (the guy who got me to watch Fat Head) and I were discussing that point last night.

    In brief, a doctor hands out advice for 30 years, then sees that the advice he’s been handing out is wrong. There’s only two possible outcomes.

    Either he can be in denial about it by conveniently cherry picking information that still supports his advice, and continue unchanged. After all, the trust that a doctor needs from his patients would be undermined should he reverse his position. And without that trust, the doctor doesn’t have patients, and loses his job.

    Or, he can reverse, and write a book about it, and go on the talk show circuit, and blog about it. I’m so very happy for the second group, from whom I’ve learned a lot, and probably saved my life (and at least my quality of life).

    The first group adopt the strategy described in “Mistakes Were Made (but not by me).”

    • Bret says:

      And without all this government spending and regulation interfering in the health care system keeping bad ideas alive and keeping the people who support those bad ideas employed, doctors peddling this bad advice would lose their jobs a lot quicker.

    • Walter Bushell says:

      I have to quote the case of Ignaz Semmelweis here. And you have to consider the quilt of giving fatal advice to thousands of people over your career, if you admit to yourself you were wrong, and the more obvious you were wrong the wurst. So must people will retain their good image of themselves and stick with the old dogma.

      “My karma ran over my dogma; now my car is out of alignment and my dog is dead.

  18. Firebird7478 says:

    To me Statin is an Island in New York City.

    And that’s all it should be.

  19. Mark says:

    Remember when big tobacco first started falling over. All this situation needs is for one person, just one person, to sue, and the whole house of cards will start crumbling. Of course, by that stage, all the profiteers will have disappeared and taken their money with them.

    • Bret says:

      Got to disagree here. The mainstream anti-fat/pro-grains bias has dominated the public research arena for so long that these hooligans can find enough “evidence” to “prove” just about any claim they have made. They can call in endless “experts” who will reinforce the standing dogma with their testimony and thereby make the plaintiffs look like quacks in the eyes of laymen.

      Yes, you and I (and everyone reading this) know what they are saying is neither evidence nor proof, but a judge and jury I’m not so confident in. Economic illiteracy and scientific ignorance are pandemic throughout our society. I think it will likely take decades for this paradigm of b.s. to unravel completely.

      I’m afraid you’re right.

  20. gollum says:

    I can’t comment on the study itself.
    It is a meta-analysis (read: cooking other people’s data) and even if valid, confirms what we knew already: that they poisoned us for no good reason with PUFA (and transfats from margarine in the 70s-early 90s).

    I am writing because I can confirm that the backpeddling cardiology plays that tune.
    “Um – Um – Um – that may perhaps be so but is no license to indulge in fat, saturated raises cholesterol and we know cholesterol to be a genuine risk factor. Tadaaa”
    Straight from gleichschaltung quality newspapers.

    They only forgot one little thing, if satfat ups C and C makes your heart gummy it should have shown up in the endpoints. People deficient in fats are not too good with this logic thing, but this is a no-brainer?
    I’ll put it down to “good enough to fool the rubes” (just like the “energy went into the oceans” GW bandaid – sounds good but actually, greenhouse effect does not add some fixed warmth – the radiation is driven by T alone)

  21. NM says:

    And on the radio this morning in the UK was a big-pharma apologist. He promised that side-effects of statins barely exist. He knows this, because big pharma ran some studies. But he won’t let anyone see the data from those studies. Just trust him! And he was basically calling anyone who reported on such side-effects MURDERERS for daring to scare people from taking these miracle drugs.

    Sadly, he was barely challenged, and left the impression that anyone who questions the Miraculous Church of Statin is some sort of barbarian.

    Figures. And if his living depends on big pharma, he probably believes what he’s saying is true.

    • Alex (@FedFanForever) says:

      Still, what is a person to do? Isn’t it prudent to trust the doctors over some bloggers? That’s common sense right?

      • Nick S says:

        Authority without evidence is not particularly compelling.

      • Pierson says:

        Evidence is evidence, regardless of who or what says it. As such, whether the information came from a book, a paper, or a blogger, if the methodology, logic, and conclusions check out, they check out

  22. Gretchen says:

    Just saw a commercial looking for patients that had taken Lipitor and had gotten diabetes. I think the lawyers are starting to smell blood. Never thought I would be rooting for class action lawyers.

    Yeah, that’s a tough one. It’s like rooting for the mafia.

    • Walter Bushell says:

      But who else can take on the government, the medical industry and the food industry and lawyers as lawyers don’t use weapons, as do governments and organized and unorganized crime.

  23. Nads says:

    We obviously need to reduce cholesterol more! Or I think people aren’t swallowing the statins properly!

  24. Bob Johnston says:

    I love this – more ammo for when I’m trolling the American Heart Association’s facebook page. :-)

  25. Ulfric Douglas says:

    Gretchen : “Just saw a commercial looking for patients that had taken Lipitor and had gotten diabetes. I think the lawyers are starting to smell blood.”
    I do hope so,
    evidence may mount more quickly for Statins > Alzheimer’s, time will tell.

    I’m happy to have extricated myself from bad food just in time, in my opinion… believing absolutely NOT in the Doctors really helped.

  26. Becky says:

    The really fascinating thing is the tendency for some articles describing the 30-year advice as wrong to double back on themselves and implode. As in, “Now, this doesn’t mean, of course, that you should start eating saturated fats.”

    • DDJ says:

      That’s the part that gets me. They could prove conclusively that saturated fat isn’t the problem, and it would still go something like this: “We have proven that saturated fat does not raise cholesterol, and that high cholesterol isn’t really the best predictor of heart disease anyway. But that doesn’t mean you should start eating saturated fat, because, as we all know, saturated fat might raise your cholesterol, and that could lead to heart disease.”

  27. helen says:

    I just found you yesterday. My cardiologist Dr. Alves recommended thie web site. I believe I heard on the Fat Head movie that women over 65 should never take statin drugs. That they could cause complications and cholesterol is not necessarly bad for them. I can not find it now. Can you direct me to information that womed should not take statin drugs. My Dr. is very strongly advocating that I take a statin, I have told him no but he asks me every time I visit. I need something written to back up my reasons. I have diabetes and irregular heart beat. He claims statin drugs will help both of these. If he continues i most likely will change doctors.

    I’d suggest picking up a copy of “The Great Cholesterol Con” by Dr. Malcolm Kendrick. You can also find lots of articles about statins on his blog:

    http://drmalcolmkendrick.org/

    If your doctor thinks statins will help with your diabetes, he is seriously misinformed. If anything, some statins are associated with a higher risk of developing diabetes. That doesn’t necessarily mean statins are causing the diabetes, but it’s a possibility.

    http://www.webmd.com/cholesterol-management/news/20130523/could-statins-raise-diabetes-risk

  28. Taysha says:

    While reading about the new study on a news site, I couldn’t help but notice the first comment. It read something like “Saturated fat is not bad? I’m going to celebrate with donuts!”

    I don’t need to point out the massive injury to my face when it met the keyboard at that.

    We should all wear helmets when reading health articles in the media.

  29. Brenda says:

    “although it wouldn’t surprise me to learn Monsanto has tried patenting a laboratory salmon that can’t reproduce.”

    Monsanto hasn’t, but biotech company AquaBounty Technologies has:

    http://www.dailyfinance.com/2014/03/06/2-more-grocers-nix-biotech-salmon-walmart-remains-mum/?icid=maing-grid7%7Cmain5%7Cdl22%7Csec1_lnk3%26pLid%3D453681

    Yeesh.

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