Heart Disease, Statins, and Diet
Why Conventional Recommendations for Those at High Risk for Heart Disease Usually Makes Matters Worse
By Dr. Mercola
One in four Americans over the age of 40 is currently taking a statin drug under the illusion that it will decrease their risk for heart disease.
Dr. David Diamond is a neuroscientist with a PhD in biology. He’s also a Professor of Psychology, Molecular Pharmacology, and Physiology at the University of South Florida and a Research Career Scientist at the Tampa VA Hospital.
He ended up investigating both diet and statins as a result of having to address issues with his own health, and his conclusions are very different from the current status quo in medicine.
Why Low-Fat Diets Are Ill Advised for Those at High Risk for Heart Disease
Fifteen years ago, when applying for life insurance, Dr. Diamond discovered he was at high risk for heart disease. It surprised him, as he’d been in good health, even though he’d gained about 20 pounds over the course of 15 years, and he had no family history of heart disease.
“When I looked at the blood test results, I saw why [I was placed in the high risk category],’ he says. ‘Triglycerides are recommended to be below 150 and even preferably below 100. My triglycerides were stratospheric at 750.
My high-density lipoprotein (HDL), which is called the ‘good cholesterol’ and which you’d like to be above 40 or 50, was about 20 to 25.
That combination of extremely high triglycerides and very low HDL put me at about a 15 times greater risk for heart attack compared to someone with optimal lipids.
I really believed this was an anomalous blood test. I figured I would exercise more – and I’ve exercised all my life – and follow the recommended American Heart Association (AHA) diet, so I cut back on my fat.
In six months, I figured, everything would be back to normal. But after six months, the numbers were the same.”
He admits being completely ignorant of nutrition. The only thing he “knew” was that saturated fat is bad for you, that it causes heart diseases, and that cholesterol clogs your arteries — both of which he now knows are wrong…
After exercising and following the recommended low-fat diet for five years, his triglycerides were still in the 700-800 range and his HDL remained at about 20-25. Making matters worse, he’d gained another five pounds.
“Perhaps the worst moment for me was when my doctor sat me down and said, ‘Okay the time has come. You’ve done your best, but diet and exercise just haven’t worked for you. It’s time for you to go on medication.’ He recommended fish oil, niacin, and a statin.”
What Causes Elevated Triglycerides?
Before acquiescing to medication, Dr. Diamond decided to do some research on triglycerides. His doctor had diagnosed him with familial hypertriglyceridemia, a genetic disorder, but Dr. Diamond still wanted to read through some of the medical literature just to be sure he’d done everything he could before taking a drug.
“Well, the very first paper I looked at indicated that triglycerides are primarily produced from excess carbohydrates, particularly glucose and fructose,’ he says. ‘And as far as HDL levels, you see an association of low HDL levels in people who have high blood sugar.
There was an obvious connection of carbohydrates in the diet to triglycerides and HDL. I was astounded by this. This was the first of many epiphanies I’ve had while studying cholesterol, diet, and heart disease.
I figured that what I needed to do is not to avoid the fat; I should avoid the carbohydrates! I actually talked to my doctor about this.
And of course he said to me, ‘Well, you’re going to take a bad situation and make it worse, because by going on an Atkins-type diet, you’re increasing the likelihood that you’ll have heart disease.’
Nevertheless, from a few studies that I read at first – and it has now become a few thousand studies – I’ve learned of the linkage between carbohydrate consumption, elevated blood sugar, and triglycerides.”
Reducing Carbohydrates Is KEY for Reducing Triglycerides
Counter to his doctor’s advice, Dr. Diamond dramatically reduced non-vegetable carbohydrates and ate as much saturated fat as he wanted. And what happened?
After stubbornly remaining at nearly 800 for five years, his triglycerides plunged to 150 — without any drugs whatsoever — and his HDL increased dramatically, from 30 to 50.
Indeed, I’ve treated many patients with high triglycerides, including people with levels upwards of 1,500-2,000, and I’ve seen patients’ triglyceride levels plunge in as little as five days when cutting out carbs and increasing healthy fat.
So the really good news about high triglycerides is that you can achieve rapid reversal by changing your diet.
“This had a profound effect on me,’ Dr. Diamond says. ‘I was indignant, really, and this sense of indignation grew on me. I really felt I had been deceived; that it’s the carbohydrates that we need to worry about, not the fat in particular.
The demonization of saturated fat and cholesterol — I realized it actually led me astray… To clarify, the good fats are the natural fats. When you’re talking about natural saturated fats, you’re looking at high-quality fats.
Partially hydrogenated fats – especially the unnatural oils like corn oil and soybean oil, which becomes heavily oxidized [when heated] — are very unhealthy.
It’s not that I eat fat with reckless abandon. I avoid those artificial vegetable fats and stay with the fats that are really high quality, such as avocado and olive oil. I cook with coconut oil.'”
This experience prompted him to develop a course at the University of South Florida called “Medical Ethics,” which teaches students how to evaluate flawed methodology in the science on nutrition and heart disease. In 2011, Dr. Diamond also gave a lecture on his experience and on the flawed advice we’ve been given on diet, cholesterol and statins titled: “How Bad Science and Big Business Created the Obesity Epidemic”, which has gone viral with about 150,000 views.Deciphering the Truth About Dietary Cholesterol
Before his self-chosen re-education, Dr. Diamond firmly believed that dietary cholesterol clogs arteries and causes heart attacks. It was part of his medical education, but that too, he discovered, was all wrong. Your liver, to a great extent, actually controls the level of cholesterol in your blood. And while people with heart disease have cholesterol clogging their arteries, it’s not the consumption of cholesterol that causes it to accumulate there.
Clogged arteries are caused by inflammation in the arterial wall, and your body attempts to protect itself by packing cholesterol there. The question is, what causes the inflammation in the arterial wall? Key dietary factors promoting chronic inflammation are: sugar, trans fats, and oxidized cholesterol, which again is what you get when you heat partially hydrogenated vegetable oils.
Coconut oil, on the other hand, is a healthy saturated fat that is excellent for cooking, as it oxidizes much less than other oils when exposed to high heat. It tends to not promote inflammation; on the contrary, coconut oil has potent anti-inflammatory activity.
On a side note, a novel point about coconut oil that many are unaware of is that for those of us, including myself, who suffer from a genetic condition called beta thalassemia — or chronic low cholesterol, which can be quite harmful — coconut oil can be used instead of drugs to raise your cholesterol. Conventional medicine insists that high cholesterol is bad for your heart, but excessively low cholesterol can have very serious consequences, including an elevated risk of dementia, depression, and aggression. Low cholesterol can also cut your life short.
“For elderly people, someone over 60 years of age, high cholesterol is associated with better health and greater longevity. This completely surprises people. But people 65 years of age with a total cholesterol of about 300 will live longer than someone whose cholesterol is below 200,” Dr. Diamond says.
Interestingly, research has shown that vegetable oil consumption actually lowers cholesterol levels. Hence if you give corn oil to people who have heart disease, you would expect them to have a greater longevity and better health. Alas, that’s not what happens. A trial1 published in 1965 tested that hypothesis by giving men diagnosed with heart disease a couple of tablespoons of corn oil each day. Their health outcomes were then compared to men with heart disease who did not receive corn oil.
“After about three years, the results were absolutely crystal clear. The men who consumed the corn oil had lower cholesterol and twice as many heart attacks and deaths from heart disease compared to the group that basically ate what they wanted.
To me, this should have stopped any kind of belief that lowering cholesterol is good for you, and the paper explicitly stated that people with heart disease should not consume corn oil; it is unhealthy. And yet, the American Heart Association still recommends corn oil to people. Why? Two reasons: 1) it lowers your cholesterol and 2) the corn oil industry is a sponsor to the American Heart Association.”
Doctors Are Misinformed About Nutrition for a Reason
When Dr. Diamond lectures about cholesterol to physicians, they’re often astounded by what they learn. Unfortunately, their “educated ignorance” is not by accident. If studied carefully, you’ll find that the medical profession’s ignorance about cholesterol was crafted by careful design, starting over a century ago with the Flexner Report, funded by the Carnegie and Rockefeller foundations, who wanted nutritional science to be excised from the medical school curriculum.
They were successful in this endeavor, and for the past hundred years, most physicians have been, and still are, nutritionally ignorant. The reason for this, if you haven’t yet deduced it, is because if you know how to heal with food, why would you prescribe drugs? What doctors are taught about nutrition in medical school is wrong. And it’s wrong by design to generate disease that increases profits for the drug companies, which are outgrowths of the chemical industry that the Carnegie and the Rockefeller foundations supported in the 1900s.
The Difference Between Absolute Risk and Relative Risk in Medical Research
Dr. Diamond recently published a paper2,3 together with Dr. Uffe Ravnskov. In it, they highlight the deceptive use of absolute risk versus relative risk in medical research. There’s a massive difference between the two, and it’s easy to confuse people with relative risks. Specifically, Drs. Diamond and Ravnskov emphasize that the way statin researchers have been presenting their data has been deceptive.
“This absolute risk versus relative risk goes back to a paper published in the Journal of the American Medical Association (JAMA) in 1984. Before the statin era, the drug cholestyramine, which is a bile [acid] sequestrant, can lower your cholesterol dramatically. The men with the highest cholesterol levels averaging about 290 were put on cholestyramine versus placebo.
After seven years and over $100 million spent, you had almost no incidence of heart disease and 95 percent of the men had absolutely no adverse effects. The first issue was: is high cholesterol unhealthy? The answer from this study is it’s not… But something funny goes on now when you have drug companies supporting this [cholesterol view] or people who have a goal that is not purely scientific.”
A typical heart disease study might last two or three years, and in that time, perhaps two percent of the people in the placebo group will have a heart attack. The actual incidence of heart attack is then two percent. In the group receiving the actual drug being studied, perhaps one percent of the people have a heart attack. The difference between the placebo and the treatment group is one percent — this is the absolute risk reduction. An absolute risk reduction of one percent means you need to treat 100 people to prevent the incidence of heart attack in just one person.
“Where people start playing games is in what’s called relative risk. When people publish these studies and they talk to the media, they don’t want to say that they have a one percent reduction of heart attacks. That doesn’t sell drugs very well… The difference, they say, is going from two heart attacks [in the placebo group] to one heart attack [in the treatment group], and that difference is 50 percent.
By reducing one heart attack in one person out of 100, using relative risk reduction you now can say that you have reduced heart attacks by 50 percent. That was the primary point of our paper: that this is deceptive and this is misleading people because when you talk to the doctors and you talk to the public, they have no idea that this has been a manipulation of the data to basically amplify the very small effects of statins,’ Dr. Diamond says.
It’s a statistical aberration. The reason it’s misleading is because people don’t know that you’re talking about the incidence of an adverse event across two groups expressed as a ratio. People assume that 50 percent means half of the whole population that’s treated.
People have told me that when they take a statin and when they see numbers like 30, 40, or 50 percent reduction, they almost feel immune from getting a heart attack. When I explain to them that basically, ‘you feel lucky that you’re going to be that one out of 100 that’ll have one less heart attack,’ then they don’t feel so emboldened. When I started talking about the adverse effects of statins, I’ve had many people stop taking their statins.”
Other Ways Studies Are Skewed and Biased
At the end of the day, what really matters is what your risk of death is: the absolute risk. According to Dr. Diamond, it’s quite common to see NO effect on actual all-cause mortality from the lowering of cholesterol. Now, some may say that even if statins only save one person out of 100, it’s still worth taking the drug. But this must also be balanced with the side effects, which include muscle pain, muscle damage (including damage to your heart muscle), and inhibition of the production of the coenzyme Q10.
This is massively important, as it not only raises your risk of heart problems, but also dementia. Statins also raise your risk for diabetes, which is a risk factor for heart disease and all cause of death. It’s also worth noting that “known” side effects can be minimized by the way you design the study.
This too is covered in Drs. Diamond and Ravnskov’s paper. One way side effects are hidden is by allowing participants to drop out of the study. Obviously, if people have side effects, they want to quit and remove themselves from the trial. But by excluding those who withdraw due to side effects, and looking only at the subjects that remain in the study to the end, you effectively only look at people who fared reasonably well on the drug.
“The other thing I find amazing is now that we’re looking at the next generation of the proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors, suddenly these statin researchers are talking about people who are statin-intolerant. They say as many as 20 percent of people who take statins are intolerant because of all the side effects. They’re coming out of the woodwork talking about side effects, because now, there’s another drug that potentially exceeds the statins.”
Another aspect of side effects that Dr. Diamond addresses in his paper is that low cholesterol is associated with an increased risk for cancer. People with a cholesterol level of 180 or below have a much higher risk for cancer than people whose level is 280. Statin trials typically do not run past four years, which is generally not long enough to detect increases in cancer.
Yet despite the short duration of the statin trials, you still find studies showing significant increases in cancer. For example, one recently published decade-long study showed that women who had been on statins had more than twice the rate of breast cancer compared to women who were not on statins. “I think there’s little doubt that low cholesterol in general and particularly statin-reduced cholesterol increases the likelihood of developing cancer,” Dr. Diamond says.
Beware of the Next-Gen Cholesterol-Lowering Drugs
The next-generation drugs designed to lower cholesterol are the PCSK9 inhibitors, and according to Dr. Diamond, these drugs are virtually guaranteed to cause harm. At present, they’re not yet available on the market, but FDA approval is being sought. These drugs do not work in the same way statins do. An enzyme called PCSK9 causes a degradation of the LDL receptor that rebinds to low density lipids (LDL).
If you don’t have that receptor, the cholesterol stays in your blood. By blocking this enzyme, you end up with more LDL receptors on the surface of the cell. The LDL can unbind to the cholesterol and bring it inside the cell. As it brings more cholesterol inside the cell, you’re extracting the cholesterol from the blood, hence it’s very effective at lowering the serum cholesterol. Since the mechanism of action is completely different from statins, they won’t have the same side effects, but that doesn’t mean it’ll be ultimately beneficial for your health.
“Basically, you got a drug that’s relatively a ‘cure’ at this stage as far as mechanism is concerned. But what you’re going to end up with are these cells that are going to be chockfull of cholesterol, and that’s really unnatural,’ Dr. Diamond says. ‘The PCSK9 is this beautiful system in which you have balance. You bring the LDL into the cell, the LDL receptor disintegrates, and everything is in balance. This drug is going to take it out of balance.
You’re going to interfere with the functioning of the cells, because they are loaded with cholesterol that shouldn’t be there. Ultimately, it’s very likely that this will contribute to all kinds of dysfunctions… Brain cells are not supposed to be filled with cholesterol. They need the cholesterol, but they need it to be able to build new brain cells and build new connections, not to have those cells chockfull of cholesterol.'”
It’s Never Too Late to Take Control of Your Health
Twenty-five percent — or one in four — of Americans over the age of 40 are currently taking a statin. If you are watching this and you’re not taking a statin, congratulations. But it’s almost guaranteed that someone you know is on this drug. My slogan is “take control of your health,” and Dr. Diamond’s story demonstrates just how important this concept is. Even PhDs need to do their own research when it comes to their health. No one is immune to well-meaning but misguided advice from their doctors.
“I don’t give people any medical advice; I’m not a physician,’ Dr. Diamond notes. ‘I give people information. I make it very clear that people need to take their own health into their own hands… The problem we have is that if your doctor says you need to take a statin, it’s almost as if that’s been etched in stone. People are very resistant to changing their minds.
Now, when they actually hear me lecture — and I give full-day lectures; I cover about the brain, nutrition, and heart disease — once they’ve heard my lecture then they stopped taking their statin, because I go over all the data. I give the historical perspective as well as the mechanistic perspective.
But I’m very reluctant to talk to people, because it causes such conflict. Because after they talk to me, they go back to their doctor and the doctor says, ‘Well, what medical school did he go to?’ It’s the typical response. ‘Who are you going to trust? I’m your doctor.’ It’s a serious problem for people to know who to trust.”
Indeed, many people face real dilemmas when it comes to their health, because they’re unsure of who’s actually giving them the correct information. I would encourage you to look at your situation and ask yourself, “is what I’m doing working?” If like Dr. Diamond you’ve been on a low-fat diet and exercising for ages and see no improvement, chances are you got it all wrong. The question then becomes, are you willing to try a different route?
From my perspective, there’s simply no doubt that conventional dietary recommendations are largely responsible for many of our current health epidemics, including obesity, diabetes, heart disease, and cancer. In essence, the recommendations are converse to the truth. Most doctors recommend a low-fat, high-carb diet and artificially sweetened “diet” foods and beverages to lose weight and protect your heart.
In reality, this is a sure-fire recipe for insulin resistance, diabetes, obesity, and related diseases. Many would lose weight and improve their health by turning the traditional food pyramid upside down as shown in my Food Pyramid for Optimized Health below, getting the majority of your calories from healthy fats, along with a moderate amount of high quality protein, and very little non-vegetable carbohydrates. Vegetables can be consumed without limits.