New Research Confirms We Got Cholesterol All Wrong

[hotdog]

I think the headline holds a lot of truth.
If you don't have existing heart disease the benefit of statins is miniscule. The trial outcomes on average show about a hundred healthy people need to take statins for years to prevent one heart attack.

Coupled with that is the risk of the statins giving you diabetes.
For every 3 heart attacks prevented a new case of diabetes is created.
I wonder what they do to your liver.

I also think that it is very likely that cholesterol is not the issue here as the people who have heart attacks show an equal spread of high and low cholesterol.
Researchers are suggesting statins may have an anti-inflammatory effect which to me seems the most likely reason they show a small benefit in existing heart disease patients.

If you want a way more significant drop in CVD risk look to the japanese diet (fish oil) which is a way better anti-inflammatory.

I am pretty sure anyone reading this already eats fruit&veg, exercises and supplements with fish oil. You have likely already reduced your CVD risk way more than statins ever could.

 

[Vince]

My understanding that most preventive doctors will not give you a statin unless you already have the growth of plaque

 

[dnfuss]

I'm not going to plow through 30,000+ studies on statins on Pubmed nor am I intending to defend statins.

Apparently, you're not willing to "plow through" any studies. You really ought to have a defensible intellectual position if you're attempting to refute someone else's.

I'm merely pointing out this headline for this topic: ""No evidence exists to prove that having high levels of bad cholesterol causes heart disease, leading physicians have claimed" is bogus.

Based on what? Your statement is simply a conclusion. Your argument, such as it is, is utter ad hominem. I.e., they must be wrong because they're kooks, at least someone I'm quoting says they are. And by the way, it is generally considered appropriate to cite your source when you quote multiple paragraphs verbatim from someone else's writing. Otherwise the reader might think you're actually the author of all that italicized material in your post.

This is a very complicated scientific issue with extremely serious implications for both individual medical diagnosis and treatment and public health policy. A cogent discussion of the evidence mandates a thorough digestion of a very large number of clinical studies going back many decades. If you would like to be part of such a reasoned discussion, I'm sure everyone would appreciate the point of view you'd bring to the table. If you simply want to assert that the position cited in the reference in post #3 must be wrong because lots of people say it is, that adds nothing of value.

 

[dnfuss]

About statins reducing mortality, I came on this searching the NY Times:

https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.14993

An observational study, not a randomized, controlled trial. Useless for any purpose other than proposing clinical trials.

Here's an example of a randomized, controlled trial: The ALLHAT-LLP trial, the only large clinical trial of statins not funded by a pharmaceutical company. That trial's raw data is available for anyone to review (the statin trials funded by pharmaceutical companies will not release their raw data, a disturbing development in modern research which medical societies are beginning to move to prohibit). It covered over 10,000 subjects over an average period of approximately five years. They had elevated LDL cholesterol labs but had not had a heart attack, i.e., primary prevention. Half were given a daily statin, half were not. The result? No statistically significant difference in all-cause mortality. None whatsoever. In layman's terms: over 5,000 people with high cholesterol but no existing heart disease taking a statin for five years did not live one day longer than those who didn't.

 

[DragonBits]

Seems to me the jury is still out. The old school approach though of total cholesterol and elevated LDL being a serious condition or automatically life threatening seems to be proven false.

We still have doctors that think eating eggs is bad for your health due to cholesterol. Gotta be weary of who you trust. Question everything.

I’m admittedly not highly educated on the topic so I’ll just state the obvious. Don’t be fat. Fat people have more fatal heart conditions. Everybody can accomplish that much. Do that. Worry less. My $0.02.

In fact, several studies found that being underweight at age 65 was linked to poor health and shorter life expectancy. Being overweight or obese at 65 was only rarely linked to worse health outcomes or lower life expectancy, compared to those who were at a healthy weight at age 65. Interestingly, sometimes the overweight and obese study participants had better health outcomes, but this was not a strong enough trend to recommend that older adults deliberately become overweight or obese.

What Your BMI Means For Your Health

At my age, I tend to question anything that is obvious.

 

[jdthoosier]

In fact, several studies found that being underweight at age 65 was linked to poor health and shorter life expectancy. Being overweight or obese at 65 was only rarely linked to worse health outcomes or lower life expectancy, compared to those who were at a healthy weight at age 65. Interestingly, sometimes the overweight and obese study participants had better health outcomes, but this was not a strong enough trend to recommend that older adults deliberately become overweight or obese.

What Your BMI Means For Your Health

At my age, I tend to question anything that is obvious.

Note that seriously or chronically ill people are likely to be underweight. Was this confounding variable examined?

 

[DragonBits]

Note that seriously or chronically ill people are likely to be underweight. Was this confounding variable examined?

I am not trying to defend the study, but making the point that when someone thinks something is obvious or common sense, it often isn't.

Confounding factors is quite difficult, are we to eliminate all the people with diabetes that is largely caused by being either overweight or obese? Giving up smoking is healthy but likely to cause weight gain. How about activity levels?

I think being a little overweight past the age of 65 is more protective, like a 25-27 BMI, is more healthy. (While acknowledging the limitations of BMI and very muscular). Being underweight is not healthy at all, and obese is also not healthy.

I have often read being mildly obese results in more heath problems but not in greater morality rate, and sometimes read it does cause a shorter life.

Here is a more detailed study.

The Role of Obesity - Explaining Divergent Levels of Longevity in High-Income Countries - NCBI Bookshelf

A lot of men are trying to get to a very low percentage body, but as you get older that is also clearly not healthy. (I doubt it much affects the health of younger men.) But no one discusses if this is healthy or not.

 

[DragonBits]

BTW, I am currently on a mission to lose weight. I would like to lose up to 33 lbs, giving me a BMI of 22.3.

But I would be happy at losing 23 lbs giving me a BMI of 25.3 and a weight of 140..

 

[dnfuss]

are we to eliminate all the people with diabetes that is largely caused by being either overweight or obese?

Contra common wisdom, obesity does not cause diabetes. Most overweight persons are not diabetic, although many type 2 diabetics are fat. It is the other way around: diabetes causes weight gain, most likely related to cellular insulin resistance preventing glucose from being burned for energy but instead being stored as fat. Type 2 diabetics don't become diabetic because they're fat, they get fat because they're diabetic (although they may not even be aware of it).

 

[DragonBits]

Contra common wisdom, obesity does not cause diabetes. Most overweight persons are not diabetic, although many type 2 diabetics are fat. It is the other way around: diabetes causes weight gain, most likely related to cellular insulin resistance preventing glucose from being burned for energy but instead being stored as fat. Type 2 diabetics don't become diabetic because they're fat, they get fat because they're diabetic (although they may not even be aware of it).

So then IYO what causes type 2 diabetes, and how do you avoid it? If you already have it, are there natural ways to control it?

 

[Leesto]

Doctors try to pretend the issue is 2 dimensional. All these people with heart attacks had high cholesterol? Simple solution. Lower cholesterol. Done. Well, it didn’t work.

Yes the history of the medical profession is littered with similar falsehoods. For example, salt is the cause of hypertension. Just stop eating salt and you're cured! The field of nutrition is even more confused, and then when we get to hormone replacement, then wow! We're almost in uncharted territory. That's one reason I appreciate the good folks on this forum. Most are just trying to share their knowledge and help others as we all learn together.

Doctors are excellent at some things and awful at other things. One cannot blindly accept the advice of the medical profession. I think that's especially true for organizations like the ADA and AHA. Wittingly or unwittingly they have been the purveyors of bad studies and false solutions for decades. The Government is similarly ineffective in these matters. The USDA food pyramid is a joke.

We're lucky to have thoughtful, experienced, clinical-based doctors like Dr. Saya as a contributor here and people like Nelson and the moderators who seek out honest answers and new information.

 

[dnfuss]

Gtfo with this nonsense.

Wow, that's quite a convincing argument. Basically, "I know I'm right so you're an idiot." Let's instead try to have an adult discussion.

I’ve personally known people who stuff their damn face with donuts and fast food to become diabetic.

Such anecdotes in no way prove that these subjects became diabetic from eating sugar. There is simply no clinical evidence to that effect. They didn't get diabetes from being fat, they got fat from having diabetes. It just wasn't diagnosed yet. It usually isn't until it's pretty advanced. Just because A is associated with B doesn't mean that A causes B. Again, most people who are fat do NOT have diabetes. What accounts for that if being fat causes diabetes?

Once the dr told them they were on their way to an early death they denied the prescriptions and cleaned up their diet. No more diabetes.

They still have diabetes. They just aren't exhibiting high blood sugars because they're controlling their diet, exercising, etc. So I congratulate them on managing their disease well. It should allow them to live a full and healthy life. But if they return to their previous lifestyle the high blood sugars will resume almost immediately. That is not a "cure." Persons with completely normal blood sugar control (true non-diabetics) can eat a high-sugar diet, never exercise, and they do not exhibit the high blood sugars characteristic of diabetes. Once you have diabetes, it cannot be "cured," only controlled.

 

[DragonBits]

dnfuss

What do you think does cause type 2 diabetes? You say"once you have it. it cannot be cured" so it must be acquired somehow?

 

[dnfuss]

So then IYO what causes type 2 diabetes, and how do you avoid it? If you already have it, are there natural ways to control it?

The etiology of diabetes mellitus (all types) is generally unclear.

Type 1 is characterized by a complete or nearly-complete destruction of the body's pancreatic beta cells (somewhat simplified, these are responsible for the production of insulin). It appears to be an autoimmune disorder. It generally manifests during youth or adolescence and seems to be predominantly genetically driven, although which genes are involved and what triggers them remains, again, unclear. It always requires exogenous insulin to control the patient's serum glucose levels.

The etiology of Type 2 is even more unclear, and Type 2 diabetics can essentially move into the Type 1 category if they lose all (or most of) their beta cells. This can happen after years of uncontrolled high blood sugars, which in and of itself is toxic to beta cells. Type 2 diabetics may have a normal or close-to-normal number of beta cells and still produce insulin. But the production is often insufficient and/or poorly regulated. They may have an inadequate first phase response but stronger second phase or less commonly poor basal regulation, or they may exhibit dysfuntional hepatic glucose production. On top of that they often exhibit very high cellular insulin resistance (i.e., insulin they produce is not adequately taken up and used by their (mostly muscle) cells).

The causative factors for Type 2 diabetes mellitus are completely speculative. A good guess might be that there is a strong genetic component that requires one or more environmental factors to be triggered (i.e., both the genetic and environmental factors are necessary, but likely none alone is sufficient, to manifest the disease). But these are only guesses and much clinical research remains to be done.

The sine qua non for diabetics, Type 1 and Type 2, and pre-diabetics (i.e., mild diabetes), is to normalize blood sugars. The goal is to have the same serum glucose levels as those with naturally truly normal blood sugars. Consistently elevated blood sugars over many years, even those classified as pre-diabetic, cause serious complications and lead to increased morbidity and mortality.

At least for now (although research continues) diabetes cannot be cured. But blood sugars can be controlled so that one can live a full life free of the complications of the disease.

For solid information about high blood sugars and how to normalize them, I highly recommend the book "Diabetes Solution" by Dr. Richard Bernstein. It explains how everyone, including pre-diabetics and diabetics, can and should have normal blood sugars. The protocol (highly simplified) laid out therein for achieving truly normal blood sugars in a nutshell is as follows (note that each step includes all the previous ones, i.e., if #1 isn’t enough, you add #2, if still not enough you add #3, etc.):

1. First and foremost, a low-carb diet. No one with blood sugar control issues can achieve truly normal blood sugars without it, no matter what medications they're on. Dr. Bernstein's diet calls for less than 30 grams of carbohydrate per day for average-sized adults. I try to adhere to that, but it is pretty tough and may not be necessary for everyone. If your blood sugar control is only marginally compromised, you might first try below 100 grams per day. If that's not enough, try going down to 50 grams per day, then 30.

2. If diet alone is insufficient to achieve normal blood sugars, add exercise, both resistance and cardio.

3. If still insufficient, add oral agents. Metformin first and foremost. If that doesn't work, there are others and other combinations to try.

4. If still insufficient, add insulin.

As for how to avoid diabetes, there simply is no clinical evidence. If you have a strong genetic pre-disposition to diabetes it is likely inevitable. Conversely, for those whose genes guarantee them absolutely normal blood sugars throughout life (a fairly significant percentage of the population) there is no need to do anything (although there are other reasons besides avoiding diabetes for adopting good health habits). For those in the middle, e.g., you haven't been diagnosed as diabetic but you have one or more diagnosed diabetics in your immediate family and you have a tendency to chubbiness and you've had slightly elevated fasting glucose tests (several over 95), I would suggest trying to follow a low-carb diet, take regular cardiovascular and resistance exercise, and have an initial Oral Glucose Tolerance Test (see Glucose tolerance test - Mayo Clinic) and follow up every year or two (you can try this at home if you want an approximation of the OGTT: https://bit.ly/2Iixe87, although it's not as definitive). I'm afraid that's all medical science has to offer at this time.

 

[dnfuss]

That’s a lot of words to say you are born with diabetes.

That's not what I said at all. I'm sorry if you find the number of words daunting, but it's a complicated subject. Read my response to DragonBits if you want a more thorough explanation.

Well one friend for example lived to his 30s without diabetes. Overweight most of the time. Ended up with symptoms and dr confirmed diabetes. He simply stopped eating junk, lost 70 lbs, and had no more issues the rest of his life which did end short for non related issues.

Your friend's progression to diabetes is quite typical. Glad he lost weight. Maybe when you say he "stopped eating junk" that meant he began following a lower-carb diet, which helps to control blood sugars. But without seeing his test results, neither you nor I have any way of knowing if he was actually maintaining normal blood sugars or not. Most doctors follow the ADA guidelines, which view fasting and post-prandial blood sugars far above normal as acceptable when research finds that they result in a clear level of diabetic complications. So perhaps he continued to have elevated (although lower than previous) blood sugars. Anecdotal stories such as this unsupported by clinical evidence are really meaningless.

Maybe I have diabetes. Maybe we all do. We just have to get fat enough to know it. Makes zero difference to me. I focus on results and actions. I’ll take the same action and not be diabetic. Anything else is just mental masturbation. See a lot of that on this forum unfortunately.

Maybe you'll be diabetic if you stay slim and maybe you won't. If you eat a typical high-carb diet and have completely normal blood sugars you do NOT have diabetes, whether you're fat or not. If you eat such a diet and have blood sugars above certain levels then you are diabetic. That is the definition of diabetes. We do NOT all have diabetes. The great majority of the population does not have and will not develop diabetes whether they get fat or not. Again, it is a fact that most people who are fat do NOT develop diabetes. How is that explained if being fat is a primary cause of diabetes? As for mental masturbation, I would view making conclusory statements with no scientific support except "common sense" (which very often conflates correlation with causation and is ultimately proven to be completely wrong) to be exactly that.

 

[DragonBits]

dnfuss, I was being careless when I posted diabetes is "largely caused by being either overweight or obese". I should have said that being overweight or obese are major risk factors, but not a determining cause.

 

[dnfuss]

dnfuss, I was being careless when I posted diabetes is "largely caused by being either overweight or obese". I should have said that being overweight or obese are major risk factors, but not a determining cause.

You are correct, and I applaud your attention to detail. But I try to avoid using the term "risk factor" in public discussions, as lay people tend to misunderstand it, thinking it means causative, rather than correlative. It is true that there is an association between obesity and Type 2 diabetes. And there can even be an improvement in blood sugar control when Type 2 diabetics lose weight. But that does not mean that gaining weight, in and of itself, causes Type 2 diabetes. A subtle distinction, but an important one.

 

[dnfuss]

I don’t need blood tests to tell me the trend of increased type 2 diabetes follows the obesity trend in this country. Are there exceptions? Sure. Just proves the rule.

It's not a matter of a few exceptions. While many Type 2 diabetics are obese, the majority of obese patients don't have diabetes. I agree there's been an increase in both the incidence of diabetes and obesity over the last 50 or so years. But we disagree about the relationship between them. Because A increases with B doesn't mean that B causes A. The science doesn't indicate any clear pathway by which obesity would cause diabetes. There is simply no physiological process that would explain that. But the explanation of how diabetes promotes obesity is completely consistent with our understanding of its basic biochemistry.

My friends case was way simpler than that. He ate less food and less sweets. That’s it. Doctor told him to forget the meds and just do routine blood work. His story is not unique. Don’t give a damn what some study paid for most likely by a pharma company says.

Again, conclusions based on anecdotes aren't really determinative of anything. Neither you nor I can express a meaningful view about your friend's case without access to his history, labs, etc. And I have no idea what your reference to a pharma company study is supposed to mean. I don't think I've ever heard or read of a pharmaceutical company doing any study on this point.

I’ve had relatives develop diabetes or pre diabetes. It was onset by an awful diet, and surprise, obesity. Some lost weight to fix the problem. Some did not.

I'm sure you've had plenty of relatives who developed diabetes, as have I. I'm sure many/most of them ate high carbohydrate diets and were obese. That does not mean that obesity caused their diabetes, only that they occurred together. I have seen and read clinical descriptions of many cases of diabetes over the years. While losing weight will, by reducing the glucose overload at the cellular level, improve blood sugar control somewhat, only in the mildest cases of diabetes will it bring down blood sugars to anywhere near normal levels. The average doctor will tell a patient that they're "just fine now" because they've brought their fasting glucose down from 180+ to the 110s and never bother to check their post-prandial glucoses, which inevitably still spike to unacceptable levels. Such patients are almost always still clinically diabetic, just less so than they were before losing weight. They are by no means "cured" and still quite likely to develop the insidious complications of diabetes over the ensuing decades.

Once again, correlation does not prove causation, but lack of correlation does prove lack of causation. How do you account for the majority of overweight people who do NOT develop diabetes if it is in your view a primary driver of the disease?

 

[Parajack]

I’ve been fighting off Statins for several years now. I’m more or less my own advocate on the health front but still a slave to the FAA and my flight surgeon twice a year.

I’ve had high total and LDL-C for most of my adult life (62). I was very healthy until I wasn’t and became quite sickly about 5 years ago.

A few years ago I was eating super clean with no meat or dairy. All real whole food, greens/veggies, organic, often raw. Vitamix rarely cooled off. My blood work was unchanged and still numbers were high.

Then I had the Boston Heart eval done and more of the same. Healthiest scores on all of the inflammatory markers and all of it except the Lipid section where of course I was at strong risk of CHD and it was strongly recommended that I start taking statins.

After years of chasing this around I’ve come to my own conclusion. Why in the world would anyone start messing with one of the most critical systems in the body - the endocrine system? It’s hard enough to achieve and maintain optimal health without being ‘drug’ down by dangerous drugs for the long term.

The other thing I’ve learned is that you can have a far and away greater impact on your health without drugs just by paying attention to what you feed your body... it’s not rocket science.

 

[Sakuraba39]

That was 12 years ago. My last blood work in August showed my Total Cholesterol at 142, LDL at 89, and HDL of 40, and VLDL at 13. Quite a reduction without any type of prescribed medication.
.

What's your TRIG?