Fibs about Fat, Confusion about Cholesterol
- alazris
- 9 minutes ago
- 12 min read
“Science is the belief in the ignorance of experts.”
-Nobel Prize winning physicist Richard Feynman.
Healthcare has become a field dominated by so-called experts. Self-declared “experts” are typically academic doctors who claim to be sufficiently prestigious that we should trust them blindly. Either they disregard the need to provide any data since they are experts, or their studies are pharmaceutically financed, poor quality, restrictive as to who is being studied, and utilize end-points that are not clinically relevant or that are deceptive, as we will see not only with cholesterol studies, but also with studies of diabetes, dementia, and atrial fibrillation we will review in future blogs. They dismiss any studies or experience that verges from their pre-ordained thesis, and almost always they have ties to industry which is how they achieved their “expert” status.
When esteemed scientists such as Albert Einstein, Richard Feynman, and Carl Sagan warn us to avoid basing our beliefs on words uttered by such experts—imploring us instead to always be skeptical, critically thinking, and relying on common sense and a diversity of thought—they understood how easily “science” can be manipulated by self-interested charlatans who owe their status to their willingness to work for industry. As Sagan says: "Science cuts two ways, of course; its products can be used for both good and evil,” adding that: "Science is more than a body of knowledge. It is a way of thinking; a way of skeptically interrogating the universe with a fine understanding of human fallibility." He and Einstein warned us that "If we are not able to ask skeptical questions... we are up for grabs for the next charlatan” who, in this context, could be a prestigious academic doctor in a white coat telling us to trust them since they are, well, an expert!
Nowhere is this more evident than in medical science, where expert panels draft consensus statements that always seem to echo what specialists and pharmaceutical companies advocate for their own self-interest, where outliers are always excluded and often ridiculed, where bad studies drafted by industry fill the footnotes of any analysis. The authors of consensus statements are typically academic doctors who conduct large studies for drug companies thus enriching themselves and their institutions. The sponsors of these statements are large organizations that are fronts for either industry or specialists. And the megaphones of these “expert panels” and their typically fallacious conclusions are those who accept money from industry, whether the media, Congress, or doctor groups.
This is well illustrated when we discuss fat and cholesterol, something we have written about before but, in the light of new cholesterol guidelines, is worth revisiting. Cholesterol is one of the most onerous and dangerous medical myths perpetrated by our medical community. It is something that has no backbone in science but is embraced not only by self-serving experts and medical organizations, but also by virtually all doctors and even most patients, primarily due to cognitive dissonance combined with the its normalization over decades. It is always refreshing to find patients who dispute the entire basis of our cholesterol-laden medical world, and I have found many who do. In fact, far more thinking people dispute expert advice regarding fats and cholesterol than do doctors, most of whom seem willing to simply trumpet whatever the so-called experts tell them to do.
Evil Fats:
As noted in our last blog about cholesterol, the fat-cholesterol myth arouse in the 1960’s with several debunked, unethical, and paid-off “scientists” who fabricated a myth between fat and heart disease. It became ingrained in clinical guidelines, the food pyramid, and in physician nutrition advice. It launched a massive war against fat that hit its stride in the 1980’s, with low-fat diets and products being viewed as the path to good health. But, despite “experts” assuring us otherwise, and doctors buying in without any critical analysis of facts, not a single study tie fat consumption to heart disease or any other medical disease. Just the opposite in fact.
The low-fat craze increased the incidence of diabetes, heart disease, cancer, and dementia, with sugar replacing fat as our primary vice. Not only were we eating more sugars and fake ultra processed fat built to create safer fat (margarine) both of which are highly inflammatory and medically dangerous, but were now eschewing healthy fats. Fats from certain unprocessed oils (olive, avocado), nuts, seeds, vegetables are health promoting, feeding our gut microbiome, reducing inflammation, and cutting down risk of diabetes, heart disease, and dementia, all of which became forbidden by low-fat experts.
Recently the nutrition community has pivoted, embracing healthy fats and assailing sugars, trans-fat (margarine), and ultra processed carbs. Doctors, however, continue to preach low-fat, unaware of how their advice can adversely impact their patients’ health. And the nutrition community remains divided on animal fats, with recent studies showing saturated fats to be dangerous; these are fats derived from land mammals like cows and chickens, as well as the milk and eggs from those animals.
But is saturated fat bad? Frankly, we don’t know, because studies simply group all animals in one group: animal fats, and by inference, saturated fats. However, some animals, despite having saturated fat, seem to be healthy, and we have included several references at the end of this blog and have discussed this in a past blog. These include organically grass-fed beef/milk, and organically pasture raised chicken/eggs, all of which are high in anti-inflammatory properties and healthy omega three fatty acids. They feed our gut microbiome and lower inflammation. Bad animals include industrialized beef and chicken that are fed pesticide-laden ultra processed pellets injected with hormones and antibiotics, and kept in tight cages. All meat can become inflammatory if fried, smoked, or laden with preservatives.
Thus, fat is not bad inherently; many fats are potentially beneficial. We don’t know if too much fat, even good fat, can be harmful because no good studies have been done. Fat is calorie dense, but it also suppresses appetite and lowers our insulin levels and insulin resistance. We know from recent data that people who eat a lot of fat, even saturated fat, have lower dementia risk, and likely would have less diabetes and heart disease.
Cholesterol as the Monster
Cholesterol is crucial to so many of our organs and health processes, especially the brain. Those most harmed by cholesterol deficiencies are people with evolving brains (under age 30), and elders (those over 60). In fact, a recent study shows that in people over 60, higher cholesterol levels equate to longer life and less dementia. When we lower cholesterol through medicines or diet we deprive our body of a crucial ingredient to our health and longevity. This is why the new cholesterol guidelines—as well as the obsession of the medical community with measuring and lowering cholesterol—are frankly dangerous.
Why are we so concerned about cholesterol, even though not a single study justifies our maligning of this important fat? When our blood vessels become diseased it puts us at higher risk of stroke, heart attacks, and vascular disease. And that disease is created by the deposition of cholesterol plaque on vessel walls, plaque that can rupture and cause blood vessel catastrophe. Since plaque is made of cholesterol, we assume that higher cholesterol, especially LDL cholesterol which is what is the primary culprit, will predispose us to heart attacks and strokes. But this is not true. Plaque is not about how much cholesterol is floating around our blood. It’s about how much of that cholesterol sticks and forms plaque. What causes it to stick? Inflammation, which ironically increases when we eat less fat and more sugar. Thus, low-fat diets and drugs may lower cholesterol, but they also paradoxically increase the formation of plaque.
Studies are very clear about this fact. (These studies can be found in my books, Return to Healing, Curing Medicare, and Interpreting Health Benefits and Risks) Just as many people with heart attacks have low LDL cholesterol as high cholesterol. Drugs other than statins (more about them later) that effectively lower cholesterol do not reduce the risk of strokes or heart attacks; some like niacin increase the risk even with low LDL. As documented in my many books, studies find no link between cholesterol and plaque formation. Studies used by cholesterol-obsessed experts are almost always observational, not randomizing people between the high cholesterol and low cholesterol groups, which is problematic as many people with high cholesterol have more real risk factors (smoking, poor diet, less exercise) that do cause poor outcomes. It’s not the cholesterol, it’s the other stuff, but without good randomization the cholesterol could be make to look like the culprit. Just like Subaru drivers have a lower heart disease rate than drivers of Ford F-150’s, its not the car that’s causing the problem, it’s the demographic difference between people who tend to buy these two types of cars.
Cholesterol Lowering Medicines as the Solution
We have now become a medical society obsessed with measuring and lowering cholesterol by any means possible and as low as possible; the “normal” range of LDL has dropped precipitously over time, with the new guidelines putting abnormal as anything over 70, meaning that approximately 95% of adults have cholesterol that is too high and must be fixed. Even as we fix the number, our patients are not healthier. Many are less so, given that some medicines increase death, dementia, and strokes even as they lower cholesterol to a range that make doctors smile, and others like statins are harmful to some groups and casue serious problems in many. In areas of the world where people live longer and have very little heart disease, few people measure or treat cholesterol.
And that’s the point. Inflammation is the glue that causes cholesterol not to stick, not to form plaque, not to induce heart attacks and strokes. So rather than focusing on lowering cholesterol, we should be more focused on lower inflammation, which cholesterol medicines do not achieve. And lower inflammation helps us no matter what our cholesterol measurement is. How do we lower inflammation? Good diets (healthy fats, fiber, fruit/vegetables, less sugar and processed/fried foods), exercise, stress reduction, good sleep, communality. Not medicines. Not number-fixing.
Statins are a special case. We think of these drugs as effective because they lower cholesterol, but that is not the case. When statins reduce heart attacks, they do so no matter what the cholesterol is, or how low they push the cholesterol. Low doses are typically as effective as high doses based on randomized trials. These medicines lower inflammation in our heart blood vessels, and as such they can reduce plaque deposition and prevent plaque rupture. They are only effective in younger people (under 80) with a high risk of heart disease; the few studies in people over 80 show no benefit and significant risk. The best study of the benefits of statins (all doses, all cholesterol levels) in younger people with a high risk of heart disease, these medicines reduce the incidence of a serious heart attack or death by 1% over 5 years. No one else benefits, no matter what their cholesterol is or how low we push it.
And statins are not without risk. They clearly cause muscle destruction, and this is worse in the elderly and in athletes. They can cause pain, weakness, falls, fatigue. Recently studies in elders with dementia show that statins paradoxically increase risk of stroke and heart attack, and they may worsen dementia, something that makes sense since the aging brain needs cholesterol to function. And yet, 50% of statins are prescribed to people over 80 primarily to lower cholesterol. Also, a recent analysis shows that they may increase the risk of plaque when used over time, as well as harming our heart muscles which could be catastrophic to people with congestive heart failure, another group of people often put on these medicines to lower cholesterol. Thus, even the one medicine group that may help with plaque is not effective when we use it to lower cholesterol and can be frankly dangerous if given to certain patient demographics.
The New Cholesterol Guidelines
The American Heart Association (AHA) and American College of Cardiology (ACC) released new cholesterol guidelines that, when juxtaposed with the facts stated above, seem absurd, even dangerous, but have been embraced by doctors, the media, and others who draft protocols and clinical guidelines. This is an expert panel recommendation, using a plethora of old data that is based on poor studies drafted by drug companies and largely debunked and observational. No new information is provided, and many studies that contradict the goals of the drafters of these guidelines are simply ignored, as are any “experts” who disagree with the drafters of this declaration.
The AHA is largely financed by pharmaceutical companies that are heavily invested in convincing Americans to use more drugs to lower cholesterol levels lower and lower. The ACC is not only financed by drug companies but more significantly is simply a trade group for cardiologists that benefits from creating a scare that would convince more patients to seek cardiology care. The academic “experts” who drafted the guidelines are a who’s who of prestigious physicians who conduct studies for drug companies at their institutions, not only enriching themselves and their medical schools through drug company largesse, but also finding themselves on TV and in the media often as representing the last word on cholesterol and its “treatment.”
The guidelines are clearly aimed at increasing drug use. They do this two ways. First, they expand the scope of who should have cholesterol measured and treated, imploring us to measure/treat kids, adults, and elders, with no upper limit of age. Of course, given that no GOOD evidence is available about cholesterol in kids and young adults, and that we know that elders benefit from higher cholesterol and are harmed by treatment, these guidelines may harm the young and old. Second, in the absence of good studies linking cholesterol to disease, these experts ASSUME that high cholesterol causes heart attacks, fallaciously making cholesterol into a surrogate for vascular disease.. And they demand that everyone, from young adults to people over 100 years old, push the LDL under 70. This not only implies that everyone should have cholesterol measured, but that 95% of adults—and an unknown number of kids—will require medicine since only about 5% of people have LDL under 70. Even though not a single robust randomized trial shows benefit from pushing cholesterol so low, and that ample evidence shows us that it is frankly dangerous in certain groups, the “experts” are very firm in promoting aggressive number fixing and have fixed the LDL number at 70.
The creation of a dramatically low surrogate goal will push doctors to prescribe not just statins, but high dose statins AND likely 2 or 3 additional drugs to push the LDL lower than most statins are capable of doing. High dose statins are severely muscle destructive. Other medicines—mostly Zetia and Repatha, very expensive medicines that have not been shown to reduce death or significant heart disease despite effectively lowering LDL—will drop the numbers, but will they help anyone? It is unlikely. Will they harm people? Maybe. But by assigning cholesterol to a position of power whose levels are a surrogate for health and whose lowering under 70 is deemed to be essential to our health, we have invented a disease detached from real heath outcomes, a disease that demands us to spend tens of billions of dollars on useless and maybe dangerous drugs in 95% of the population. All to get a certain number to be below an artificially constructed guidepost.
Most onerously, the guidelines don’t discuss lifestyle changes beyond a cursory note that they may not lower cholesterol enough. We know from populations outside the US, people who eat well, who walk often, who live in integrated communities live longer and have lower heart disease burdens than even Americans bombarded with drugs to push LDL under 70, and they live longer without measuring or treating cholesterol. How does this simple and obvious fact not decimate the very basis of the claims made by the “experts” who drafted this study? How is common sense and critical thinking not making us all ridicule the audacity of the AHA, ACC, and academic “experts” who make a statement so dismissive of reality?
Or course, if we as a medical community preach wellness, that will hurt the bottom line of the companies that pay the AHA’s bills, that enrich “experts” and institutions that are fixated on cholesterol, and that make far too many doctors and patients feel better by taking drugs to fix a number, even as they continue to eat poorly and not exercise and be at high risk of heart disease. The number looks great, the patient, well, he/she is inflamed, clogged up, and prone not only to heart disease but a plethora of illnesses. And of course, since high dose statins cause muscle weakness and fatigue, they will not be able to exercise as much. But their numbers look good, so all is good, right?
Again, some people do benefit from statins, but that has nothing to do with their cholesterol levels. Statins help vascular inflammation in a certain subset of people regardless of their cholesterol. And no one benefits from any other cholesterol lowering treatment, or even from high-dose statins that push LDL into the gutter. Between physician guidance on fats and their number-fixing obsession regarding cholesterol, these guidelines will invariably make people sicker, weaker, and more vulnerable as compliant doctors blindly do what they are told by experts and push LDL under 70 in all circumstances. This is especially true given the ubiquitous age range of the measuring/treatment paradigm the guidelines demand, the dismissal of lifestyle changes which do not fix numbers even as they repair our body, and the potential risk of high dose medicine use.
Number-fixing is almost never the answer. Cholesterol is a weak surrogate and, unless very high (found only in hereditary cases) does not predict heart disease. Lowering that surrogate is not helpful, even with statins. All the cholesterol guidelines will accomplish is to sell more drugs, create more visits to specialists which will lead to over-testing, over-treatment, sickness, disability, and stress. Thank you to our medical experts for yet another guideline that helps big pharma and specialists even as it harms real people.
References:
Meat/saturated fat and mental decline, CAD
Grass-fed beef, better fat content, no good studies on outcome
Pasture Raised Eggs
Comments