I worry about a number of things, but I don’t worry that my body is trying to kill me - 7 little-known facts about cholesterol

When I discuss the LCHF diet with friends, family and increasingly with my clients all over the world, the conversation generally goes like this:

1. I describe the diet and it’s effect on obesity and type 2 diebetes.
2. I talk about running on fat.
3. I talk about the fear of fat.

And it is always at stage 3 that things get difficult. We have an ingrained fear of fat, and saturated fat in particular. The way I try to get past this point is what I have coined “My Cholesterol Chat”. But I always fear that I have not got the message across as clearly or as simply as I ought be able to.

Here is a great post from Zoe Harcombe that does just that.

http://www.zoeharcombe.com/the-knowledge/we-have-got-cholesterol-completely-wrong/

A simple summary which I shall use from now on goes like this:

1. Cholesterol is of vital importance to every cell in our body. It is a good thing.
2. It is so important that we make it ourselves, we do not get it directly from the cholesterol in food.
3. There is no such thing as ‘good’ or ‘bad’ cholesterol. HDL and LDL are just the transport mechanism by which it is distributed from and returned to the liver.
4. If you lower the amount of fat in your blood (for example be losing weight on any diet) then LDL tends to be raised. Why would losing weight be bad for us?
5. Statins prevent the body from making cholesterol; this thing that is vital to every cell in our body! It is now clear that the tiny number of already ill people who do benefit from taking statins do so not because of the way it lowers cholesterol but more likely due to the way it combats inflammation. Aspirin does the same thing, but without the side-effects.
6. Eating animal foods has no impact on cholesterol levels; please stop worrying about saturated fat!
7. Lastly, consider this: Who is gaining from this whole business if the increased lifespan of the tiny number of people who do benefit from taking statins can be measured in days?

Zoe’s summary is perfect:

“The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.”

Taking a Statin might change what it says on your death certificate - but it will not change the date.

Seven Mind-Numbing Facts about Statins 

1) The NHS spends about £500 million each year on Statins. Enough to build a large hospital each year or pay 16,000 nurses. Most of this money ends up as income for drugs companies, who in turn pass a lot of it on to clinical research units who produce papers that say how great statins are.

2) Statins work by lowering the ‘bad’ cholesterol in our blood. This in turn is expected to lower our risk of Coronary Heart Disease (CHD) and prevent us from dying of a heart attack or stroke. They may have other effects but we do not know for sure. The fact that they reduce cholesterol has elevated statins to be a "wonder-drug". Experts have told us we should all take them every day. And many of these experts are now rather rich.

3) There is not a strong correlation between people experiencing a heart attack and having high cholesterol.  In fact many studies show that low cholesterol may be just as dangerous. Cholesterol is carried by Lipoproteins that can be ‘bad’ (Low Density Lipoproteins) or ‘good’ (High Density Lipoproteins). Recent research has shown that the key attribute of LDL Cholesterol which may be associated with CHD is it’s particle size or density; small-dense is bad, larger less-dense is good. We do not measure this attribute in UK blood tests but we know that it is NOT affected by statins – note that it IS affected by diet. We also know that many populations with the highest cholesterol often have the lowest rates of heart disease.

4) We all need cholesterol. Every cell in our body depends on it in order to grow. Our brains in particular need cholesterol; indeed 25% of the cholesterol in our bodies lives in the brain. Studies have shown that higher cholesterol is associated with better memory function. It would not be surprising if a lowering of cholesterol had a negative effect on brain function.

5) There is a startling lack of research that proves that taking statins will reduce CHD.  One of the most widely respected studies (The Heart Protection Study, 2001) made its authors famous and led in part to the recent boom in statin use. The study's authors claimed that statins would save thousands of lives and should be prescribed to anyone with even a modest risk of CHD. What the study actually proved was that about 0.5% of men who already have CHD will live a few months longer if they take a statin. The other 99.5% will not. Men who do not already have CHD cannot expect that taking a statin will prevent them getting it. The all-cause mortality figures show that there is negligible improvement in life expectancy gained by taking a statin, despite the much lauded claims that they will save your life!  You are just as likely to die, but you might die of something else. By contrast the positive effect of taking Aspirin has been shown to be much higher. 

6) The likelihood of experiencing side-effects from taking statins is estimated at less than 1% by the drug manufacturers and somewhere between 5% and 20% by most GPs. Who would you trust here? The list of possible side-effects on a packet of statins is long and scary. Amazingly it includes Type 2 Diabetes, which in turn increases the risk of CHD as well as being a particularly nasty condition to grow old with. Also, recent research is suggesting a possible link between statins and Parkinson’s disease; remember how the brain needs cholesterol? The risk of taking a statin might be literally mind-numbing.   

7) If someone says that your mother may die if she stops taking her statin then you should reply by asking: “So what are the chances of that happening?”.  A recent article in the British medical Journal explained how on average the best outcome we can hope for from taking statins is to extend life by a few days. This is really not very impressive, is it?

  

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My thanks to the brilliant Dr Malcolm Kendrick (author of The Great Cholesterol Con and Doctoring Data) for the title of this post and for exposing the scale of the miss-use of statistical data in clinical trial reporting.

Time to Help Bust that Cholesterol Myth

So, the elephants in my room at night are Fats, and in particular Saturated Fats.  I am eating lots of them for breakfast, lunch and dinner. The received wisdom suggests that I will die of a heart attack, perhaps as early as next week.  

My wife Jane started using a LCHF diet last year and it was her growing prowess on a bike that really impressed me. As she trained more she bacame less and less reliant on extra energy to power her through the long training runs leading up to the RideLondon-Surrey 100 bike event last August. This made me start thinking about the effect this could have on long distance running.

Up until about a year ago I was definitely in the low-fat camp. I ate lots of good and some not-so-good carbs and I avoided fatty foods. I have never liked margarine and so there was always butter in the fridge. I disliked low-fat food as it is often very sweet (got to make it taste nice after removing the good stuff!) . We ate healthily but it was easy to put on weight, even when running a fair bit.

Opinions have been changing fast in recent years.  

The belief that saturated fats and their association with Cholesterol have a direct relationship with heart disease has led to a demonization of natural foods like meat and butter, and the growth of huge industries for low-fat food and cholesterol-lowering foods and drugs. One of the first studies to refute this belief came from the American Journal of Clinical Nutrition in 2010. (http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract).

Here are a couple of  recent findings – you may have heard about them recently on the news:

• A highly-regarded recent study suggested that there is no difference between saturated fats and any other kind of fats in terms of their relationship with heart disease. (http://annals.org/article.aspx?articleid=1846638 )
• Recent research suggests that the actual relationship between cholesterol and heart disease is not as simple as having too much ‘bad‘ LDL cholesterol in our blood.
  (http://www.bmj.com/content/347/bmj.f6340)

When Jane and I started looking at LCHF diets this seemed like a giant leap of faith. What if the research is wrong? What if it is just a fad? But our interest in this subject has coincided with a wave of new research. Almost every week there is a new study published or another scientist or doctor ‘coming out’.  The mainstream is starting to shift, like all rivers do over the years.

What I particularly like about the latest research is that far from being bad for your heart health, a high-fat diet is quite likely to be better for it. This is not so suprising; as Jane put it the other day, "If a high fat diet is bad for you then how did our species ever evolve in a world governed by the survival of the fitest?".

 

There is compelling evidence that the relationship between cholesterol and heart disease lies not simply in your level of ‘bad’ LDL cholesterol, but in the size and number of the LDL particles themselves http://www.internationaljournalofcardiology.com/article/S0167-5273%2899%2900107-2/abstract. The lower the size, and hence greater the number of LDL particles, the higher the risk. This particle size is known as LDL-p (or alternatively LDL patterns A and B as shown below) . 

This LDP-p value is not reported in the standard UK cholesterol test and is not mentioned on the NHS web sites or that of HEARTUK “The Cholesterol Charity”.   Perhaps because this ‘charity’ like several other charities are sponsored by companies that make cholesterol-lowering foods. 

Research also suggests that the high-carb diet recommended by most dieticians, doctors and the NHS promotes a higher LDL-p (pattern B) value, whereas the high-fat diet that most humans have followed for the last million years promotes a lower (healthier) LDL-p value.

Now this is relatively new science, but the drugs industry and health authorities have yet to seriously challenge any of the data being produced. This may be because a debate might draw more attention to the facts. Or it may be because the research that they produce in support of their own views is generally so weak that most A level students studying research methods and statistics would be tempted to tear it apart (read this and see what I mean http://en.wikipedia.org/wiki/Seven_Countries_Study). This study formed the basis of the ‘cholesterol myth’. 

While you are at it, watch the Cerealkillers movie (http://www.cerealkillersmovie.com/) for a description of LDL-p and how it relates to your diet. This documentary also discusses the success being achieved by Tim Noakes and others in treating Type 2 Diabetes with a controlled LCHF diet. It’s a fascinating programme.

Take a look at the graphs below. The left hand side of the first graph below has a lot of scatter, but then there are lots of other causes of heart disease. The right hand side is more interesting as the dots are mostly closer to the line (less deviation implies a stronger trend).  So while the graph does not necessarily prove that less saturated fat will always lead to more heart disease than average it does suggest that more saturated fat will normally lead to less heart disease than average.

So if the countries that eat the most saturated fats appear to have the lowest levels of heart disease then why would we want to lower our cholesterol?

Can you spot France and the UK in the graphs?

This is known as the French paradox - the French eat the most saturated fat, their cholesterol is not that high and they have the least death from heart disease. They also have the lowest levels of obesity. This may be because the French are very resistant to anything that changes their national character, particularly their food; they are still eating the same way they have for decades. So why aren’t they having so many heart attacks as us? Perhaps because their higher saturated fat diet is actually protecting them. I’d be very interested to know if they have a lower LDL-p value than we do in the UK. 

The graphs above were taken from the following web sites. Well worth a read.

http://authoritynutrition.com/6-graphs-the-war-on-fat-was-a-mistake 

http://bebrainfit.com/lifestyle/drains/exposed-why-cholesterol-doesnt-cause-heart-disease

http://karenlebillon.com/2012/09/17/french-kids-dont-get-fat-why

The bible on this subject is here: http://drmalcolmkendrick.org/the-great-cholesterol-con/