Should we worry about cholesterol?

by Michael Patrick O'Leary

A version of this article appeared in Lakbima News on Sunday October 10 2010.


I was surprised when I first arrived in Sri Lanka to hear a dinner-party guest discussing her bowel movements and haemorrhoid surgery. I soon learnt that Sri Lankans of all classes were somewhere on a spectrum between health-conscious to hypochondriac. Everyone “knows their numbers” as they say in the States. A conversational gambit might be, “I have cholesterol. How high is yours?”

I was once a small part of the Study of Health and Stress carried out by Professor Sir Michael Marmot at London University. My cholesterol levels were “at the high end of the normal range”. Medication was not suggested. In London I was advised to avoid cashew nuts, avocadoes and prawns. In Sri Lanka I was told to eat as much of them as I could.

Why has cholesterol become such a villain? As Jenifer Anniston used to say: “Here comes the science”. Cholesterol is a natural substance produced by the liver to provide structure to animal cells. The brain is 70% fats and cholesterol.

High density lipoprotein (HDL) carries cholesterol from peripheral tissues in the arterial walls to the liver. From the liver it is excreted with bile. Cholesterol is transported from the liver to peripheral tissues. When cells need extra cholesterol they call for low density lipoprotein (LDL) to deliver the cholesterol into the cell’s interior. Up to 80% of cholesterol in the blood is transported by LDL. Why then does the common wisdom condemn LDL as “bad” and deem HDL “good”?

Perhaps some mental confusion has arisen because of a misunderstanding of the term “risk factor”. Risk factors are not the same as causes. Gary Younge wrote in the Guardian: “Because two things are co-related it does not mean that one causes the other. Shark attacks and ice cream sales both rise in the summer. That does not mean that ice cream attracts sharks or people react to fear of sharks by eating more ice cream”.

If heart attacks happen more often to people who have high LDL, smoke, are overweight and suffer from stress it would be wise to give up smoking, lose weight and relax. It would not be wise to take drugs to attack LDL while leading an unhealthy life style.

In 1953, Ancel Keys published a paper in which he argued that five times as many Americans as Italians died from heart attacks because Italians ate healthier food. Using data from six countries he claimed to prove the dangers of animal fat. If he had studied all 22 countries for which he had data the results would have been different. Even within Italy there were differences in the rate of deaths from heart attacks, even among people following the same diet.

The Framingham, Massachusetts, study is often used to argue the case for lowering cholesterol. The reality is that almost half of those who had a heart attack in Framingham had low cholesterol. Women with low cholesterol were as likely to die as those with high levels.

Professor Donald Light says 85% of new drugs offer few benefits, but risk serious harm . He cited the marketing of statins. Sponsored researchers and writers converted the complex relationships between heart disease and saturated fats into the simple message: “cholesterol kills”.

The first statin was launched in 1987. Pfizer’s Lipitor achieved sales of $10 billion a year, becoming the world’s best selling prescription drug.. Sales have soared further to around $27 billion because of huge increases in those with “high” cholesterol. In 1990, official guidelines meant that 13 million Americans “needed” statins. In 2001, “high” was redefined and the market increased to 36 million. Five of the fourteen authors of the new definition were paid by Big Pharma. In 2004, a further redefinition expanded the market to 40 million. Eight of the nine experts on that panel were taking money from the drug companies.

UK government heart advisor Professor Roger Boyle suggested every man over 50 and every woman over 60 should take a daily statin. This approach has been taken to ridiculous extremes with some “experts” recommending that statins be put in the public water supply. The American Journal of Cardiology recently published an article suggesting that statins should be offered in complimentary packets with burgers.

There can be side-effects from statins. They have been associated with pancreatitis, tendon problems, depression, sleep disturbances, memory loss, sexual dysfunction, cataracts, osteoporosis, peripheral neuropathy, hemorrhagic stroke and rare cases of interstitial lung disease.

Rhabdomyolysis is a very serious condition which may account for a quarter of cases of acute renal failure, and may have a mortality rate as high as 20%. It causes vomiting, confusion, coma, abnormal heart rate and rhythms and absence of urine production, usually about 12–24 hours after the initial muscle damage.

Dr H Brian Brewer Jr, a senior scientist at the NIH (National Institute of Health), wrote: “No cases of rhabdomyolysis occurred in patients receiving [Crestor] up to 40 milligrams”. The truth was that eight cases of rhabdomyolysis were reported during clinical trials of Crestor. The LA Times obtained FDA records under the Freedom of information Act. These records show that one patient got rhabdomyolysis while taking only ten milligrams. FDA records show that 78 patients got rhabdomyolysis taking Crestor during its first year on the market and two died. Baycol was withdrawn after at least 31 reports of fatal rhabdomyolysis.

While making recommendations on behalf of the NIH Brewer was being paid by the companies that sell the drugs.

Low cholesterol in itself can be harmful. It affects serotonin, a substance involved in mood regulation. Canadian researchers found that those with the lowest cholesterol had more than six times the risk of committing suicide as did those in the highest quarter. Dozens of studies also support a connection between low or lowered cholesterol levels and violent behavior. Low LDL has been linked to Parkinsonism.

All drugs mess with the kidneys and the liver. Why take that risk if you are not ill? Statins work by blocking 3-hydroxy-3-methylglutaryl coenzyme A reductase, an enzyme in the liver. Unfortunately statins cannot be specifically targeted on cholesterol. As collateral damage, statins inhibit other things the body needs. They deplete the coenzyme CoQ10, which is essential for energy requirements of cells. High levels of CoQ10 are found in healthy heart tissue. Statins, by reducing CoQ10 have been linked to an increase risk of congestive heart failure. The only cure is a heart transplant.

The Hippocratic Oath enjoins doctors to do no harm. They should not perform unnecessary surgery or take unnecessary risks by prescribing treatment of dubious value. Under the spurious banner of “prevention” harm is being done, anxiety is being created, resources are being misdirected and fortunes are being made.

I am not a doctor so don’t let what I say persuade you to stop taking statins. Different doctors have different views. You must decide for yourself which doctors to believe