Statin panic

A study came out a couple of weeks ago that has thrown the statin worshipers into a blind panic. The study, published in an obscure journal, indicates that people who have low LDL-cholesterol (LDL) levels have a higher risk of developing Parkinson’s disease (PD). The authors of the study didn’t actually test to see if statin drugs caused the lower LDL levels that are associated with PD, they simply made the case that patients with PD have lower LDL levels than those who don’t. In fact, the control group (the subjects without PD) contained many more people taking statins than did the study group of patients with PD, which could conceivable lead to the conclusion that statins somehow prevent PD. The authors made such a case:

In summary, our study shows an association between lower LDL-C and the occurrence of PD. This may be interpreted either as linking lower LDL-C levels etiologically to PD, or as cholesterol-lowering agents having a neuroprotective effect as regards PD. [My bold]

Despite the authors making this statement and the data itself showing what could be considered a protective effect, the pro-statin folks went ballistic. Just the idea that perhaps lowered LDL might be a factor in PD was enough to set them off at full bellow on the idea that should people actually believe this and stop taking statins, thousands of them–no, millions–might die of heart disease and/or stroke.

Dr. Peter Weissberg leads the pack.

There is no evidence to suggest that statins cause Parkinson’s disease. There is, however, overwhelming evidence that statins save lives by preventing heart attacks and strokes.

Nobody should stop taking statins on the basis of this report. If they do, they will be putting themselves at increased risk of heart attack or stroke.

Dr. Peter Weissberg is the head of the British Heart Foundation, an independent funding organization that provides considerable money to UK research on cardiovascular disease. The British Heart Foundation is also funded by, among others, companies that make statins. If you look up Dr. Weissbergs papers, you’ll find that most are underwritten by the British Heart Foundation and sometimes makers of statins as well. It would not be in Dr. Weissberg’s best interest for people to stop taking statins.

But what about the people who are taking statins. What’s in their best interest? Statins are extremely expensive and are not without side effects. In fact, some of the side effects are fatal. So, again, what about the people taking statins? Are they getting their money’s worth of protection against heart disease? And are the risk of side effects offset by the decrease in risk for heart disease? Let’s take a look.

In 2001 probably the most momentous publication in medical history occurred. It was momentous not because it was of astounding importance like Einstein’s four papers in 1905, but momentous because it has ended up affecting so many people. The document is the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, produced as part of the National Cholesterol Education Program. The goal of these guidelines is to markedly decrease the incidence of coronary heart disease (CHD). How is this goal to be accomplished? First, by a regimen of low-fat dieting combined with exercise. But if this regimen should fail to lower LDL levels to below 130 mg/dL (more than half of adults over age 35 have LDL levels of 130 mg/dL or higher), then the guidelines recommend treatment with statin drugs to prevent CHD. Readers of this blog know how great the chances are of a low-fat, high-carb diet lowering the LDL to sub 130 mg/dL levels, so these recommendations are tantamount to recommending the use of statins to more than 50% of adults over the age of 35.

I don’t know the exact number of people over age 35 in the United States right now, but I think it would be safe to say that there are at least 100 million. Half that number is 50 million, which would represent the population of adults over 35 with LDL levels of 130 mg/dL or greater. Now, let’s make a big assumption and say that a third of that 50 million can lower their LDL levels with a combination of diet and exercise (highly unlikely, but lets say it just for grins), that leaves us with about 34 million people who–according to the recommendations–should go on statin drugs. Statin drugs cost, depending upon the brand, somewhere between $2.66 and $4.86 a day, so let’s average it out to $3.75 per day. If we multiply $3.75 per day times 365 days per year times 34 million people we end up with $46.537 billion per year, a tidy little sum that will find it’s way into the pockets of Big Pharma should these recommendations be carried out. (Of interest is the fact that in the paper on low LDL and PD that started this post, the average age of the control subjects was 66.7 and 34% of them were taking statins, so the numbers I’m postulating on numbers of people taking statins are pretty much right on the money.)

If you divide this $46+ billion by 453,189 (the number of people who died from CHD in 2004 from the last available statistics) you come up with a cost of $101,923, which would be the cost per year per person saved by statin drugs if those drugs could somehow prevent every single death from CHD. Now multiply this $101,923 times the number of years the average person would have to take these drugs to prevent death, and you come up with some hefty figures. Probably well over a million dollars per person saved. Is it worth it to society to pay that much? Remember, we all pay for this either directly if we take statins or through increased insurance premiums because of others who do. And we really have to ask that question because most of the deaths from heart disease are self inflicted.

Why self inflicted? Because by far the major cause of CHD is smoking with high blood pressure running a close second. I’ve thought back on all the people I know who have had heart attacks and on all the patients I’ve cared for who have had heart attacks, and all of them – 100% – were smokers. I’ve called a couple of colleagues and asked the same question and have gotten the same answer: people who have never smoked and who have heart attacks are scarce as hens teeth. They exist, to be sure, but they are in the minority. Think back about the people you know who have had heart attacks, and I suspect you will realize the same thing. There is a correlation for you. Smoking equals heart disease. Not cholesterol equals heart disease. Michael DeBakey, the Houston heart surgeon who pioneered bypass surgery,once famously remarked that at least half the patients he operated on had low cholesterol levels.

So, why should we as a society spend over $100,000 per year to prevent one self inflicted death from heart disease? And remember, that figure is only good if we prevent every single death from heart disease. What if we only prevent half? Then the price goes up to $200,000 per year per death prevented. What if we only prevent 25% of deaths, then the price goes to $400,000. It would be nice to know how many deaths we prevent if we give a third of the population statins. Let’s take a look.

We can look in a couple of places. First we can look in the executive summary of the full 2001 report. This 12 page summary, published in the May 16, 2001 issue of Journal of the American Medical Association (JAMA), gets right to the point. The recommendations of the full report

expands the indications for intensive cholesterol-lowering therapy in clinical practice.

In other words, the recommendations increase the number of people and conditions that need statin-driven cholesterol-lowering therapy. As you go through this executive summary it becomes clear that the authorities believe that cholesterol-lowering is extremely important in both the primary and secondary prevention of CHD and that statins are the way to lower cholesterol.

Who wrote this executive summary? A long list of esteemed experts in the field of cholesterol study. Do they have any conflicts of interest? Let’s take a look. Here is the list of members on the panel that produced the summary:

Scott M. Grundy, MD, PhD (Chair of the panel), Diane Becker, RN, MPH, ScD, Luther T. Clark, MD, Richard S. Cooper, MD, Margo A. Denke, MD, Wm. James Howard, MD, Donald B. Hunninghake, MD, D. Roger Illingworth, MD, PhD, Russell V. Luepker, MD, MS, Patrick McBride, MD, MPH, James M. McKenney, PharmD, Richard C. Pasternak, MD, Neil J. Stone, MD, Linda Van Horn, PhD, RD

Here is the financial disclosure:

Dr Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, and Bristol-Myers Squibb. Dr Hunninghake has current grants from Merck, Pfizer, Kos Pharmaceuticals, Schering Plough, Wyeth Ayerst, Sankyo, Bayer, AstraZeneca, Bristol-Myers Squibb, and G. D. Searle; he has also received consulting honoraria from Merck, Pfizer, Kos Pharmaceuticals, Sankyo, AstraZeneca, and Bayer. Dr McBride has received grants and/or research support from Pfizer, Merck, Parke-Davis, and AstraZeneca; has served as a consultant for Kos Pharmaceuticals, Abbott, and Merck; and has received honoraria from Abbott, Bristol-Myers Squibb, Novartis, Merck, Kos Pharmaceuticals, Parke-Davis, Pfizer, and DuPont. Dr Pasternak has served as a consultant for and received honoraria from Merck, Pfizer, and Kos Pharmaceuticals, and has received grants from Merck and Pfizer. Dr Stone has served as a consultant and/or received honoraria for lectures from Abbott, Bayer, Bristol-Myers Squibb, Kos Pharmaceuticals, Merck, Novartis, Parke-Davis/Pfizer, and Sankyo. Dr Schwartz has served as a consultant for and/or conducted research funded by Bristol-Myers Squibb, AstraZeneca, Merck, Johnson & Johnson-Merck, and Pfizer. [My bold type]

So, you’ve got about half the panel – including the Chair – who are, like so much lint, buried deep in the pockets of the pharmaceutical companies that make statin drugs. Do you think these folks might have a motivation to promote the products of the companies that are paying them a lot of money?

But, you say, these people are only summarizing the contents of the real report as an executive summary. They don’t have any say in the data that the report contains. True, but this is where the plot thickens.

The executive summary is 12 pages long and was published in JAMA, which is sent to every physician in America free of charge. The real report is 284 pages long and has to be pulled down from online or ordered from the government. (If you go to the website referenced in the executive summary to get the full report, you are sent here. See how much time it takes you to find it) Which of the two do you think most physicians read? Why should they read the full report when the prestigious authors of the executive summary assure them that

The full ATP III document is an evidence-based and extensively referenced report that provides the scientific rationale for the recommendations contained in the executive summary.

That says it all. According to the executive summary, the full report is like Fox News purports to be: fair and balanced. And the executive summary is then a fair and balanced report of a fair and balanced report.

What do we find when we read the full 284 page report (which you can get here)?

We find that the full report presents a totally biased misrepresentation of the underlying scientific material and seems intent on promoting the use of statin drugs despite any evidence to the contrary. Not the “evidence-based and extensively referenced report that provides the scientific rationale” for statin therapy that the executive report would have us believe.

Before we get into some of the specifics of this full report, let’s recall that the Framingham data, the Queen Mother of all dietary cholesterol studies, didn’t show a correlation between diet and cholesterol, cholesterol and heart disease, nor diet and heart disease. And we need to remember that, despite all the hoopla about statins and lowering cholesterol levels, that cholesterol is an extremely important molecule. The brain is rich in cholesterol, the sex hormones are made on a cholesterol structure, and even vitamin D is built on cholesterol. Consequently, statin drug use has been associated with decreased cognitive ability and sexual dysfunction. Statins can cause liver damage and the breakdown of muscle tissue, both of which can lead to death. In my opinion, these drugs would have to lead to huge reductions in risk for death from all causes to overcome the risk one accepts by taking them.

Let’s digress for a moment and discuss all-cause mortality. Let’s say we’ve got a drug that studies show decreases the risk of death from heart disease by 50%. Let’s say that the only half the subjects in study who are taking that drug die of heart disease as compared to those subjects in the control group. At first blush, it appears that we’ve got a great drug on our hands. But, what if the same number of subjects die in both groups? The study group has way fewer deaths from heart disease but has a lot more deaths from cancer so that the total number of deaths in both groups is the same. This would mean that the people taking the drug traded their decreased risk for death from heart disease for an increased risk for death from cancer. The all-cause mortality didn’t change. All that changed was the cause of death. If we had a drug that brought about the 50% decrease in heart disease deaths in the study group and no increased death from other causes, giving a big decrease in all-cause mortality, then we have something.

The full report looks at both primary prevention against heart disease in men and women under the age of 65 and over the age of 65. And it looks at secondary prevention for men and women who already have heart disease. (Primary prevention is prevention against the development of heart disease in the first place; secondary prevention is prevention against having a heart attack in someone who already has heart disease.)

This post has dragged on long enough, so I’m going to briefly summarize the findings.

In men under 65 with no known heart disease but with risk factors, i.e. LDL of 130 mg/dL or greater, the studies cited showed no difference in all cause mortality. For those men under 65 who had very high LDL levels, the evidence showed that these men might have a slight benefit from taking a statin, but nothing to write home about. Certainly nothing that would justify putting a third of the population on statins.

In women who are under 65 there is virtually no evidence that statins do squat. In fact, the report doesn’t even produce evidence that cholesterol lowering does anything for women. The report states that it bases its rationale for treatment of women on an extrapolation of data from men.

In men and women over 65 the studies cited show no evidence that cholesterol lowering brings about any significant decrease in risk for heart disease. (Remember the 34% of subjects, average age 66.9, in the control group of the PD study mentioned at the start of this post who were on statins. According to the papers cited in this full report, none of those subjects could expect a decreased risk for CHD by taking the statins, but based on this report’s false reporting of the conclusions of these papers, a third of these folks are on statins.)

Men of all ages with diagnosed heart disease were the only group that the studies used in this report show receive an actual benefit from taking statins. And even that is slight.

Women who have heart disease and who take statins have a reduced death rate from heart disease but no decrease in all-cause mortality.

So there you have it. The giant report that, thanks to the executive summary, has driven most physicians in America to prescribe statins to practically everyone who walks through the door shows, when the data is examined, that statins are only really indicated in men who already have heart disease. They don’t do much for anyone else but put them at risk for a host of other problems while running health care costs through the roof for the rest of us.

Who could possibly benefit from this situation? How about the underwriters of the whole scheme: the drug companies and the ‘experts’ on their payroll.

We’ve got a situation where ‘experts’ paid by the drug companies write an executive summary about a report written by ‘experts’ paid by the drug companies, a report that misinterprets (purposefully?) the underlying data to make the case that the drugs made by the drug companies paying the ‘experts’ are under prescribed. Others jump on the bandwagon, making pronouncements, based on this faulty reporting, that almost everyone should be taking these drugs made by the drug companies that underwrote the entire enterprise. One buffoon, cloaked in all the trappings of academia, even made the comment that since statins are so wonderful perhaps they should be added to the drinking water. As a consequence, we’re paying billions of dollars for drugs that don’t particularly work and that cause a number of pretty bad side effects to prevent a disease that can be prevented by fairly simple lifestyle changes. Pitiful.

Is it any wonder that Dr. Weissberg got his panties in a wad when he thought a study might persuade people not to take statins. Based on what you know now, go back and read his comments to the BBC. And get mad.

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37 thoughts on “Statin panic

  1. Good analysis, Mike, as always. I think you uncovered why ideas like this take hold, reach critical mass, and become virtually impossible to counter. This idea that statins ‘save lives’ and there is ‘overwhelming evidence that they are effective.

    1. Everyone WANTS it to be true. (Take a pill, miss a heart attack. Give a patient a pill, his blood work looks better. You’re off the hook.)

    2. The idea is sound-bite simple. Cholesterol makes heart attacks. Statins lower cholesterol. Ergo.

    3. There is HUGE money to be made perpetrating it. And NONE to be made debunking it. And debunking it would only depress the public. (“Magic cure is not so magic.”)

    4. There is HUGE career value in jumping on the bandwagon. And career suicide for jumping off.

    So you have physicians prescribing the stuff universally (regardless of what they may think personally), because they’d be skewered for going against the standard of care, a ‘universally accepted’ practice, that ‘everyone knows’ saves lives.

    Someday, this whole thing will be an embarrassment to the profession, sort of like bloodletting, but it will take a half century or more.

    For now, CHD will remain a statin-deficiency disease.

    Always enjoy your insights into this stuff.

    Hi Walt–

    Great points all.  Thanks for laying them out to succinctly.  I agree.  It’s too bad, though, that people insist on magic.  Statins are the amulets of today I guess.

    Cheers–

    MRE 

  2. Could you please point me to the references for the studies leading to your following statement?
    “Consequently, statin drug use has been associated with decreased cognitive ability and sexual dysfunction. Statins can cause liver damage and the breakdown of muscle tissue, both of which can lead to death.”
    Also, I’m relatively new to your blog and I’m sure you’ve addressed this before, but could you point me to information on how you believe it is best to treat colesterol (lower the bad and raise the good)? I’m a little confused since the Framingham study showed no correlation between diet and serum colesterol levels and if statins are a bad choice -> what’s left? Thanks.

    Hi Javier–

    There are countless studies showing the correlation between statins and liver disease and muscle breakdown (called rhabdomyolysis).  Just go to PubMed and put statin AND liver or statin AND rhabdomyolysis in the search window and you’ll have more than you know what to do with.  Both of these problems are even addressed in the package insert.

    It’s the same with cognitive ability and sexual dysfunction.  Here and here are a couple of papers that can get you started.  they are by no means the only ones.

    As to how I recommend treating cholesterol problems…I don’t believe in the lipid hypothesis.  The lipid hypothesis posits that CHD is caused by elevated cholesterol.  Strange as this may sound, there is no evidence that cholesterol causes CHD.  The Framingham study doesn’t show it.  If anything it shows the opposite.  There is no conclusive evidence that cholesterol has anything to do with heart disease.  So, if cholesterol doesn’t cause heart disease, why treat it?

    If any components of the whole constellation of lipids do end up being involved in the development of heart disease, they will be triglycerides, HDL (the so-called ‘good’ cholesterol), and small dense LDL particles.  Ideally, you want to have a lot of HDL, low triglyceride levels, and low levels of small, dense LDL particles.  How does one achieve that?  Easy.  With a good quality whole-food low-carb diet.  Restricting carbs decreases triglyceride levels, increasing fat increases HDL levels, and at least a dozen studies have shown that switching to a low-carb diet reduces the levels of small, dense LDL particles.  Kind of makes you wonder why all the mainstream folks still harp on about low-fat diets, doesn’t it?

    Cheers–

    MRE 

  3. We all know how the Dr’s mentioned make their money,so let’s hear some full disclosure. I would guess that the Dr.’s Eades make their money from book sales, 3rd party products sold through their websites and from their medical practices. Judging from the recent golf trip I would guess you are doing OK finacially. (Plus you seem to have endless amounts of free time to post and respond on this blog, for which I am thankful!) Any hidden finacial agenda here? Do you own stock in a krill oil company?
    Don’t get me wrong, I hang on every word and have a bottomless trust of your knowledge to be accurate (and usually fun). Just looking for some confirmation.

    Hi David–

    I suppose your question is a reasonable one.  So here goes.  First, the Mexico trip was dirt cheap.  One of the guys who went owns a travel agency so we got rock bottom prices on everything.

    MD and I have taken a hiatus from our medical practice for a while.  We would like to go back into practice in a small way, but it can’t really be done.  Going into practice entails having an office with equipment and at least a nurse.  And it requires malpractice insurance, which is not insubstantial.  When you add all these expenses up, it would mean that we would have to spend a whole lot of time practicing just to pay the overhead, which would mean that if we were to be paid, too, it would take way more time than we would like to spend.  And, to further complicate matters, we’re not licensed in either of the states in which we spend most of our time.  Nevada requires doctors to take a National Board type of exam covering all medical specialties to get a license.  This they do in an attempt to limit the number of physicians and keep those there happy, busy, and competition free.  California requires a huge hassle to get licensed simply because California requires a huge hassle for anything.  The licensing process there is so complicated and time consuming that it requires hiring a firm (there are several that do this) to walk you through the process for a fee of about $1500.  So, although all of our income used to come from our medical practice, none does now.

    We made a fair amount of money from our books, but most of those have been in print for so long that the royalty stream has pretty much dried up.  We could write new books, but publishers aren’t interested in low-carb books right now.

    The money that we made from our books we used to make what in retrospect were some fairly astute real estate investments.  These investments provide part of our income now.

    The bulk of our income comes from our part ownership of a company that develops, patents, and sells specialized nutritional supplements through direct to consumer marketing.  We don’t carry any of these supplements on our website nor have we mentioned them in our blogs.

    We make about enough to cover the cost of hosting our site from the Google ads on the blogs.

    We have one employee, Kristi, who has been with us for about 10 years.  Kristi, who lives outside Boise, Idaho, keeps us on the straight and narrow and helps us immeasurably.  She handles, among other things, all of the shipping of products from our website and does all of our customer service.

    The sales of nutritional products on our website ends up paying for about one fourth of Kristi’s salary.  We could probably sell more, but we only put up supplements that we take ourselves.  We have a few more that we’re going to add to the catalog, but we have to get pictures and text, etc., and since we make so little money from the whole venture, we don’t have a huge motivation to do the work to get the products up on the site.

    We make a little money, but not much, on the speaking circuit.

    We invested a lot of time, energy, and some money in producing our PBS cooking show Low Carb CookwoRx that we hope someday will pay off, but it hasn’t yet.  We are still in the red from this venture.

    It may seem like I must have a lot of free time to write posts and answer comments, but I really don’t.  I used to be a voracious reader.  Now dealing with this blog eats into what was my former reading time.  I post mainly early in the mornings and late at night.  I’m writing these words at 10:45 PM.  I let the comments stack up and answer them all in one fell swoop.  The comments have begun taking more time that the actual posting because I decided early on when there weren’t many to add my comments to the comments readers make.  As the blog has grown, and more and more readers are commenting, I don’t know how long I can continue to do this.  I’ve looked at a lot of other blogs, and as far as I can see, I’m the only one who does. 

    So, there you have it.  Is that full disclosure enough?

    Cheers–

    MRE 

  4. Unfortunately, the public has bought the lie hook, line, and sinker. Everytime I tell someone that high cholesterol isn’t a disease, it’s a symptom (if it indicates anything in that particular person), I get the “did you know you have 3 heads?” look. I strongly recommend The Great Cholesterol Con by Anthony Colpo to everyone that mentions cholesterol. All doctors should have to read it in medical school. As a doctor, maybe you can shed some light on how we can break the cycle of Big Pharma salesmen educating the doctors. Any thoughts?

    Hi Scott–

    Big Pharma is going to educate doctors forever probably.  That’s just the way the system works.  I wish it didn’t.  Big Pharma has so much money that it throws around to medical schools, research institutes, and even to doctors directly that those that get it don’t want to give it up.  It’s a tough – if not impossible – cycle to break.

    See how many doctors you can get to read Anthony Colpo’s book.  Not many, I’ll bet.  I think Gary Taubes’ book will change a lot of minds, however.  He will have a much larger platform than Anthony and will garner a ton more attention.  It will be fun to watch.

    Cheers–

    MRE 

  5. I wanted to drop some figures from the big report on someone who was just berating me to take statins for “prevention” (oy vez). I don’t suppose you could point to the relevant tables and/or numbers on risk reduction? I started trying to go through the full report, but it gave me a headache (so many thanks to you for enduring it).

    I’d be particularly interested in the figures showing the “slight” benefit to men with diagnosed heart disease. I’m guessing the report tries to spin the numbers to make them look more impressive than they are, e.g. giving relative vs. absolute risk.

    Thanks for any help.

    Hi Dave–

    The three papers used for the section on men diagnosed with heart disease were the LIPID study and the CARE study, both published in the New England Journal of Medicine and the Scandinavian Simvistatin Survival Study Group study publised in Lancet. As you can see from the abstracts, the LIPID study and the SSSG study both showed a decreased risk of another heart attack, decreased risk of dying from heart disease, and a decreased all-cause mortality. But, these decreases in risk are smaller than they appear because they are couched as ‘relative risk reduction.” The absolute risk reduction ain’t all that great, which was why I wrote that the risk reduction was slight.  The third study, the CARE study, shows a reduction of risk of recurrent heart disease but no decreased risk of death from heart disease nor from all-cause mortality.

    Hope this helps.

    MRE 

  6. Wow. That’s a doozy of a blog entry Dr. Eades. It is the first that I am considering sending to MY doctor. I only hesitate because she thinks I am a nut case (tho lovable) already. How do you pry a brilliant mind out of the statin bunkers? I am sure one ray of light is all it would take. Maybe this will do it for her.

    Marilyn

    Hi Marilyn–

    We can only hope.

    Good luck

    MRE 

  7. Hilariously, the guy advocating statin-laced drinking water is named Dr. Reckless.

    Hi Tom–

    It is hilarious.  At the time I was writing the post I was so angry that I completely missed it.  Thanks for bringing it to my attention.

    Cheers–

    MRE 

  8. Just amazing! I’ve really enjoyed reading this piece you’ve written. Thanks for such an informative expose on Statins.
    I was one of the many people who were prescribed Statins and gave up due to the significant side effects. When I went back to the doctor complaining of constant nose bleeds and sore joints within just days of starting after having been healthy, he explained that many patients do go through something like this and it can easily be fixed.
    “Get a pill splitter and go with a half dose for the first few weeks. Many of my patients have some type of side affect and it takes their bodies a while to get used to this drug.” (Lipitor)

    I found that eating lower carb improved my Lipid Profile immensely in less than a year.
    Again, thanks for your review of this piece.

    Hi Ottawa–

    At least you can now see why your doc was so adamant that you take a statin.  I’ve seen numerous patients who have had your side effects, especially the muscle pain, when they took statins.

    I’m glad the low-card diet fixed you up.

    Cheers–

    MRE 

  9. I want to thank you Dr. Eades, for giving me the information and the tools to lower my LDL from 211 to under 130, and get my doc off my ass about taking statins. This was one of my main motivations in being as hard core as I am about the Dilettante/Hedonist lifestyle (I’m somewhere harder than Hedonist but lighter than Dil) and am rapidly approaching DOUBLE the time I have spent on any other LC plan, with no inclination to stop.

    Thank you for your research. And Thank you for sharing your work and your reading with us. My wife thanks you a lot. (Regardless of whether LDL>130 is a problem or not, we all feel better that I did it on my terms and without drugs).

    Hi Max–

    Thanks so much for the kind words.  I’m glad the low-carb diet has worked so well for you.  And I’m glad you didn’t get brow beaten into taking a statin.

    Cheers–

    MRE 

  10. Michael,

    clap, clap, clap….I am giving you a standing ovation. I applaud you for your honesty and intelligence to sift through this info and see..or should I say smell whats really going on here. I would like to go on but we are having a nice winter wonderland here in PA and best be getting the sled pointed towards home. What a great job, awesome…Amen

    Hi Robert–

    Thanks for the kind words.  I appreciate them.

    Best–

    MRE 

  11. What about ex-smokers? I smoked a pack a day for roughly 20 years but quit almost eight years ago. Does my risk of heart disease go down each year I don’t smoke?

    Hi Patricia–

    Your risk should go down every with every year you don’t smoke.  Some researchers believe that a long enough time lapse will put former smokers at equal risk with never smokers; others believe that former smokers will never reduce their risk to that of never smokers.  I don’t know if your risk will ever drop to never-smoked levels, but it can’t help but improve with every non-smoking year that passes.

    Best–

    MRE 

  12. Nice post Dr. Mike. All the entertaining Eadsian phrases sprinkled about eased any weariness I had due to length.

    PS I suppose you could say that the drug companies and their panel of experts want to maintain the statin quo.

    Hello James–

    Hahahahahahaha.  Maintain the statin quo.  Brilliant!  I wish I had thought of it.

    Cheers–

    MRE 

  13. Thank you Dr. Mike for evaluating all these studies. The evidence is stunning. How can this madness continue????

    Hi Amy–

    “How long can this madness continue?”  As long as Big Pharma has a will (and a checkbook) there’s a way.

    Cheers–

    MRE 

  14. Hi Dr. Mike,
    Your comment that smoking causes CHD caught my attention. I never smoked, but as a child was surrounded by my father’s second-hand smoke for roughly 16 years. Today, I have mild asthma and numerous allergies and I’m a little worried about what this may have done to my overall cancer risk.
    Do you know of any studies in this area?
    Many Thanks,
    Tamara

    Hi Tamara–

    I’m in the same boat.  I’ve always been in pretty good shape, and when I was in medical school I had a spirometry test done (a test that shows lung function) along with a bunch of my classmates.  I had a little decrease in lung function compared to where I should have been.  My professor asked if I had ever smoked; I said, no.  He asked if I grew up in a household of smokers.  I did.  He said that a childhood of second hand smoke will bring about a decrease in lung capacity.

    I don’t know about an increased risk for heart disease.  It appears that second hand smoke can raise the risk of heart disease in people who are adults and live with smokers.  I suspect that there isn’t that much increased risk from childhood exposure.

    Best–

    MRE 

    P.S. I also had asthma as a child. 

  15. Hi Doc: Thank you for educating me as to the science behind lipid numbers. After going low-carb 4 years ago, my HDL went from a rock steady 40ish number to over 70 in the course of a year (has stayed there), while the TRIG went from the hundreds to between 40 and 50 (stayed there). I had been on, and still am, on a statin, and the HDL spike was never attributed to the higher fat nature of the low carb regime. I knew that the TRIG were low carb related. Even more telling, my brother at the same time that I began low-carb, suffered a heart attack, and began, after a successful recovery and bypass surgery, a RIGID low to no-fat diet, and has never been able to lift his HDL above 40 – and he wonders why – and his cardiologist says its a consequence of the statins (lowers both LDL and HDL). In fact, it downright drives my brother crazy to see how good my LIPID numbers are based on what I consume at meals – and his cardiologist advises him that “I am foolishly putting myself at risk years down the road” for my low carb-behavior.

    As to your “disclosure” above, I’m really disappointed to hear about the difficulties with the PBS venture. That show is by far the most enjoyable cooking show yet (and I have watched many – including George Stella’s show – did he drop off the face of the earth?) Your commentaries on all the healthful aspects of every added ingredient, vitamin absorption, are incredibly informative. Never hear that from “30 minutes” or “Bam-bam-bam.” Please be aware that you have reached many people with that show, and as to your blog – we sincerely hope you will continue. Susan and I would pay to be part of your blog if that’s what it took. Thanks again,

    David and Susan

    Hi David and Susan–

    I’m glad you enjoy the show.  MD and I are, along with our partners, executive producers of the show, which means that we are investors.  PBS is a different venue than the Cooking Network, Discovery, THC and the others.  All those others pay you for your show; at PBS you pay to play.  PBS provides an outlet for the show, but requires that the show be delivered to them in ready-to-go fashion.  The way one makes money on PBS is to produce the show, then find a sponsor that will pay more to advertise on your show that it costs you to make it.  We’ve got the first part down pat–we pay to make the show (actually, we’ve got a production partner, the PBS affiliate in Milwaukee, that took most of the financial hickey), but we haven’t found a sponsor yet.  If you know any, send them our way.

    Maybe we should start touting statins on the show–I’m sure one of the big drug companies would start throwing money at us.

    Cheers–

    MRE 

  16. Nobby Hi..if you get a mo have a squizz at the article in the new edition of New Scientist about the researcher in Swede who had participants eat double usual cal intake of junk food and do fark all exercise sans 1 hour of weight training per 7 days.

    I think i can see all manner of threads that you and your enquiring mind could extrapolate…the increased cal intake the efficacy of weight bearing exercise, evol and cals and gene expression.

    Go to it rightly and ‘may scallops rock your todger Sir’

    Sinc and with many thanks your time and effort with this blog.
    Maybe time to just answer far fewer questions. I mean you’ve covered so many topics and that in and of itself is surely sufficient to stimulate others sans answering every question that us the milling thong (intentional!) pose.

    Sinc

    Simon

    Hi Simon–

    I read the article in the New Scientist a few days ago.  I need to go back and read it more carefully because I whizzed through it as I was bringing the mag in from the mailbox.  So much to read, so little time.

    Cheers–

    MRE 

  17. Honestly, you and MD could simply cut & paste your nutritional blog entries into a book, and voila! A wonderful book. You could have it published by Sally Fallon’s publishing company (New Trends).

    Physicians’ practical experience should hold a lot more weight than clinical research. How many patients combined have Docs such as yourselves, Atkins, Lutz, Bernstein, Vernon, and others treated successfully (rhetorical)? To me, having so much success treating real patients in real-world settings is far more telling than biased, reductionist, inaccessible, improperly funded & misleadingly reported studies.

    Then again, it’s all about the money. Big Pharma, Big Food, and Big Gov’t can not allow good science to reach the public.

    Some doctors are refusing to take freebies from Pharma companies.
    Thanks for the fantastic logic!

    Karen

    Hi Karen–

    Thanks for the kind words.  I’m glad you enjoy the blog.

    Cheers–

    MRE 

  18. Hi Doc: Thanks for the education about PBS. Have you ever approached Expert Foods – the outfit that makes Thicken-Thin (at least the back of the package indicates that)? Or Bob’s Red Mill – makes almond meal and many other products that you use – of course they sell many other products (namely sugar) that you don’t exactly pitch. An Organic dairy foods outfit (Horizon Organic) comes to mind – you use many items that such a company sells. FitTV? – Blaine’s Low Carb cooking show can’t hold a candle to your show- I gather that Food Channel has ditched low carb – except for RR’s laughable attempts at it from time to time. Sad, very sad.

    We find both of you so personable and knowledgeable on the air, you make easy to prepare, delicious and healthy recipes — there must be an answer.

    Of course the real reason the show is so good is that you tell the truth, which cannot please sugar makers – high fructose makers and the like, and you just couldn’t – with a straight face – keep quiet on important issues that might rub some sponsors the wrong way.

    David and Susan

    Hi David and Susan–

    Part of the reason that sponsorship is so difficult to get on PBS is that PBS is so difficult to work with.  They have all kinds of rules and regulations as to what a sponsor can and cannot say, that many sponsors just don’t want to work with them.  One of their rules is that a sponsor’s name can’t be mentioned nor can a sponsor’s product be shown during the show, which eliminates Expert Foods right off the bat.  Sponsor’s can’t show their product being used nor can they give a contact number during the actual commercial.  We’ve come close with a number of fairly large sponsors, but in the end, these rules have been just too much for them.  But we’re still trying.  If we don’t get a sponsor, the 26 shows we’ve already done will be it.  If we do get a sponsor, we’ll keep on making shows.

    Best–

    MRE 

  19. Yeah, it is hard to make money off of plain good healthy food. Maybe try the meat and egg council? My children used to beg for the latest advertised toy so I taught them early about advertising. I told them that if the company had to advertise, the product must not be any good in some way. “Look at crayons and playdoh (their favorite pastimes). They don’t need to advertise cause they make really fun stuff.”

    Our market driven economy has thoroughly colonized health care in this country. Until health is more important than money the US will continue to create ill-health and misery. Capitalism MUST expand, even over our graves.

    This is not a political rant, exactly, but it is well to know the enemy in any war. The next conquest LC needs to make is not to convince people it is healthy, that has been done. People are resisting not the evidence so much as the economic logic. We have to figure out how it pay to investors. And you two know those issues far better than I.

    Thank you
    Marilyn

    Hi Marilyn–

    You’re right; it is a real pain. 

    Thanks for writing.

    MRE 

  20. Thank you for another great post!

    As one who was on statins, and suffered several side effects (some I’m still experiencing over 2 yrs later), I am appalled at the cavalier attitude of the pro-statins side. Well yea, you might get Parkinson’s, but you might not die of heart disease! Muscle aches? memory problems? Not from statins….and even if they are, think of the benefit!!! You may not be able to walk to your kitchen, or remember what you went in there for, but it’s a tiny bit less likely that you will have a coronary event!

    Right now CMS/JCAHO is collecting data on AMI admits to acute care facilities…what meds people are taking and being given, LDL levels, smoking history, etc….but they only want the data on patients discharged alive! I guess we can’t learn anything from those that die!

    The AHA still promotes a low fat, high carb, low protein diet, even tho studies have proven this is ineffective!

    The AHA guidelines for treating heart disease for women only mentions diet twice, exercise once, and medications 6 times (for a 12 point list!). They even call out anti-oxidants as something that should NOT be given to women!

    And, the way I understand it, the incidence of heart disease continues to climb! As does diabetes, hypertension, and obesity!!

    The lunatics truly are in charge!!!

    Hi Cindy–

    Geez, and I thought I was angry about all this idiocy.

    Let’s keep after them and change a few minds along the way.

    Cheers–

    MRE 

  21. My dad has been diagnosed with high cholesterol and diabetes type 2. The doc immediately put him on statins. After I spoke to my dad about the risks of statins and that he probably doesn’t even need them, he stopped taking them. We told the doc that we will try and get the numbers back to normal with diet alone. Treat the diabetes with low-carb and the cholesterol should improve. Doc not too happy!! Went and had some diabetes education – the speaker didn’t even mention sugar as the main culprit of diabetes (its a myth that sugar causes diabetes!!) – just that its hereditary. Also, that there is no cure and that if you are not on medication you will be in 6 months!! If I didn’t know that what she was saying was complete crap I would be very depressed. The other poor folk were mostly elderly and I could see they believed everything they were being told.

    Hi Sue–

    Pathetic.  And unfortunately, all too common.

    Good luck with the diet regimen.

    Keep us posted.

    Best–

    MRE 

  22. How is this goal to be accomplished? First, by a regimen of low-fat dieting combined with exercise. But if this regimen should fail to lower LDL levels to below 130 mg/dL…

    My LDL was 124 at last test (I’m over 35, BTW). Thankfully I wasn’t recommended statins. However, my HDL is high and the total came to over 200 so I was recommended a low-fat, low-cholesterol diet. I *am* cutting back a bit on the cholesterol by having fewer eggs, but I have no intention of eating low-fat, low-cholesterol. The low-fat, high-carb diet I was given is the type that made me 60+ pounds overweight to start with!

    Interesting about smoking and heart attacks. Only one person in my family smoked (my Dad, and he gave it up before I was born), and there are NO heart attacks in my family at all. Zippo.

    My Mom was just diagnosed with Parkinson’s. I wonder what her LDL is. I know her total was a bit high and she lowered it using flax seed.

    Hi Victoria–

    If your total cholesterol is over 200 because your HDL is so high, why worry?

    Best–

    MRE 

  23. Hi Doc: I’ve posted earlier about the sponsorship issues you face with PBS. Although we don’t have the individual wherewithal to finance the show, I did place an order for a fair number of steaks, ground beef, and roasts from Lasater Grasslands Beef, taken from your Low Carb Cookworx website. I would assume that you probably endorse their products, and from perusing their site, we’re looking forward to their shipment. What you have said on the show about organic dairy and meats really struck home when we looked at our 3 children and envisioned what it was that we were putting into their bodies with run-of-the-mill products. As a chemist, it was even more frightening. For the extra cost, we sleep better at night with the organic products. All the best.

    David and Susan Futoma

    Hi David and Susan–

    We don’t get any sponsorship funds from Lasater.  We put them on our site because we’ve used their products ourselves, found them to be a quality company, and simply wanted to pass that info along.

    Best–

    MRE 

  24. Any chance you could make some money AND provide your fans a chance to own Lowcarb Cookworx on DVD? Distribute through you website maybe? Or does someone else own the rights to it?

    Hi David–

    We own the rights to it and we plan to make DVDs sometime in the future.  Problem is that although the individual DVDs are cheap to produce, it’s pretty expensive to make the masters.   Since we have 26 episodes, it will cost more than we want to spend to make the masters.  We would have to sell a whole lot of the DVDs just to break even.

    Best–

    MRE 

  25. Hi there,

    In grad school I remember one of the seminar speakers was a synthetic organic chemist from Pfizer. He worked on the statin synthesis and I do remember he did touch on that all-cause mortality was not changed but those that died, died of something other than heart disease. I wanted to ask what’s the point of taking this if you not going to save lives but I was a young student at the time, I would have said something today.

    My 72 year old mother takes statins and eats a low fat low cholesterol diet and since that she had her gall bladder removed, reoccurence of breast cancer, and complains about heartburn all the time. She will put sugar on Total cereal in morning and wonder why don’t I worry about my cholesterol levels because I eat eggs everyday for breakfast. Now matter what I say about carbs, it is not heard even though I have a Ph.D. in biochemistry. I could tell her to stop taking statins but hey I’m not a M.D. and we all know that high cholesterol levels causes heart disease right. I wish more doctors would stop following the herd.

    By the way, thank you for your blog and you are very generous to answer our comments.

    Hi Mmmmm–

    Interesting story about the Pfizer guy.  Thanks for relating it.

    And don’t feel bad.  I am an MD, and I tell people all the time to go off statins and they look at me like I’m crazy.

    Cheers–

    MRE 

  26. I see you bash on the medical community for putting so much faith in statistically ambiguous LDL-CHD studies, but then you yourself make the following, ridiculous anecdotal claim:

    “Why self inflicted? Because by far the major cause of CHD is smoking. I’ve thought back on all the people I know who have had heart attacks and on all the patients I’ve cared for who have had heart attacks, and all of them – 100% – were smokers.”

    Yes, it has been clearly documented that smoking is a major risk factor for heart disease. Nevertheless, is heart disease not still the number one cause of death of non-smokers? Personally, I know dozens of non-smoking heart attack victims, including myself. Rare as hens teeth? If only that were so!

    Perhaps statins are not the answer, but smoking is clearly not the cause of CHD among non-smokers! If you want people to believe you, a lone outsider, in your tirade against the medical establishment, I suggest you avoid such blatantly false exaggerations.

    Hi Matt–

    “Personally, I know dozens of non-smoking heart attack victims…”  Looks like you’re indulging in a little anecdotal claiming yourself.

    I would be willing to bet that I’ve seen a whole ton more people with heart disease than you have, and I would be willing to bet that, despite your claim to the contrary, you don’t personally know “dozens” of heart attack victims who have never smoked.  Think about it and see if you can truly come up with even a dozen heart attack victims that you know who have never smoked.

    I’ll throw it out to the readers of this blog.  If any of you know someone who has had a heart attack yet who has never smoked (not someone who smoked at one time, but has quit), put up a comment.  I’m curious.

    This is not to imply, Matt, that you are or were a smoker, it’s just that in my experience and the experience of multiple colleagues, people who have had heart attacks and never smoked are thin on the ground.  That’s not to say that no one who has never smoked has never had a heart attack, it’s just uncommon.

    Cheers–

    MRE 

  27. Dr. Malcolm Kendrick’s book, The Great Cholesterol Con has some info about the smoking/heart disease connection. He says it is the same mechanism as Cushing’s disease, i.e., HPA-axis dysfunction. Haven’t finished Colpo’s book of the same title, so I don’t know if he addresses smoking as a cause or not.

    Anna

    Hi Anna–

    Anthony Colpo’s book (which I haven’t finished) fingers smoking as a risk factor (I noticed this in flipping through), but I don’t know if he posits a mechanism.

    Cheers–

    MRE 

  28. Dear Dr Eades,
    I read your blogs with much appreciation for the time and wisdom you so freely share. Let me start with my thanks.

    I have known 2 people who have had heart attacks and were not smokers. Both were coccaine users.

    I often worry about my risks of heart attack, since my brother, father, and his father, all had heart attacks in their mid-40’s. I am female, 49, diabetic. I adopted a LC WOE and lost 53 pounds, and relaxed a bit when I read your comments about smoking and heart attacks, since I have never smoked.

    However, my parents were both heavy smokers, and I know I spent my first 17 years as a heavy second-hand smoker.

    Could you share your opinion on the danger of second hand smoke versus actually smoking, as it relates to the risk of heart disease? Do you know of any studies on that topic?

    BTW, I took lovastatin for a couple years and had very severe adverse affects, (muscle pain, extreme weakness, fatigue, memory problems, depression) and stopped taking them against my doctor’s advise last September. The problems are slowly clearing up. But he denied that the statins could have caused it, in fact told me that if the statins were the cause, the symptoms would have cleared up within 48 hours of stopping.

    Thank you,
    Karen

    Hi Karen–

    Thanks for the history of what happened when you were taking statins.  I’ve heard the same story from countless people.

    As to the second-hand smoke, I’m sure it plays a slight role.  In your case, as in mine, where the exposure stopped long ago, I doubt (hope?) there is much residual effect.

    Cheers–

    MRE 

  29. Sure, you’ve probably seen more heart patients than me, as I am not a doctor. Still, at the moment I can list 21 people who never smoked who have had heart problems. Most are heart attack victims, although a few had bypasses or congestive heart failure. I’m sure I could come up with even more, although I would have to do a little digging to jog my memory or to ensure that they hadn’t ever smoked.

    Finally, as I said before, heart disease is still the number one cause of death, even among non-smokers. For example, Utah, which has a large population of non-smokers, has about a 30-40% lower CHD mortality rate than the national average. So, yes, smoking is probably a significant cause of CHD. Nevertheless, even the non-smokers still do have a fairly high CHD mortality rate (~60% that of smokers).

    Hi Matt–

    I’ve seen a few hundred patients with heart attacks, and although most of the ones I remember smoked, I had forgotten about my own partner in one of my business ventures who never smoked, yet had a heart attack.  I’m not making the case that no one has ever had a heart attack who never smoked, but the odds are much,much higher for smokers.

    Here is an interesting comment from a cardiac anesthesiologist on a discussion board for physicians only:

    I am a cardiac anesthesiologist. One day, I was doing another bypass (I have done a few thousand bypass operations) and I got to thinking about a common link between the patients. There was only one I could come up with. Smoking. With the rare exception of familial hypercholesterolemia or juvenile onset diabetes, I could not think of one patient I had put to sleep for bypass that was not a smoker. I have, however, put several to sleep with “normal”cholesterol profiles. Also, it is good reading to look at what “normal cholesterol”has been considered over time. Back in the 70’s, it needed to be blow 275 or 300. Over the years, it has continually been ratcheted down to where we are today. I would be willing to wager that if smoking is never started, the chance of needing coronary artery interventions would be about 5% of the rate that smokers/reformed smokers have. I don’t know how the “second hand smoke” group would weigh in, but I think that they would still be well below the “first hand smoke” rate. This is just my own personal observation, and I don’t have formal studies to back it up, so I just throw this out for consideration and discussion.

    He (or she) seems to have had the same experience as I have.

    Best–

    MRE

  30. I was wondering. You and Mary Dan discuss glucagon ( thanks for teaching us about that, BTW ). Can this hormone be thought of as a natural statin? Just wonderin’.

    Mary

    Hi Mary–

    Since elevated insulin levels drive a lot of metabolic processes that aren’t particularly good, and since glucagon has an opposing effect on all these same processes, and since glucagon is only up when insulin is down, you could say that it acts as a natural statin, without all the side effects, of course.

    Cheers–

    MRE 

  31. Hi there,
    I am so grateful for this blog. Thank you for your time and wisdom.
    My question is:
    We have talked about statins and cholesterol, I have a prescription for tricor to lower tryglycerites ( mine are in the 500-600 range). Now I am doing the lowcarb diet but is this going to be enough to bring levels down without the medication.
    I would buy a dvd : )

    Hi Dorothy Lee–

    In my experience with many, many patients triglyceride levels of 500-600 mg/dL come down nicely with a low-carb diet to well within the normal range.  You should discuss it with your physician.

    Cheers–

    MRE 

  32. What is your take on us folks who have the misfortune of having type 2 diabetes? Should we be on a statin because of our great risk of heart disease? Your opinion would be appreciated. Thank-you.
    Rev. Rivers

    Hi Rev. Rivers 

    I can’t give specific medical recommendations via this blog.  The decision as to whether or not you should be on statin drugs is one you will need to make in conjunction with your personal physician.

    It should be pretty obvious from my blog postings what my feelings are, but I’m not your physician.

    Good luck.

    MRE 

  33. You know Dr. Mike, I try over and over again to help my mom to not just follow every thing that her doctor “feeds” her. She is just as responsible for her body and her health as her doctor. The doctor tells her her cholesterol is high, doesn’t tell her what the numbers are but gives her statins. Has her cholesterol improved? How does she know, she doesn’t bother to ask what her numbers are. She assumes that her doctor is giving her the best tratment. I mean, we all have worked in the medical profession and she acts like she doesn’t have to think when she has a doctor taking care of her. It is frustrating and I am sure that my venting is making no sense. But at least I can vent to a doctor.

    Thanks,
    Mary

    Feel free to vent here any time. I totally understand your frustration.

    Cheers–

    MRE