No Way in Hell I’ll Take Statins

Although my other labs are in “normal” ranges, my physician informed me that the low-density lipoprotein cholesterol (LDL) is very high at 202 mg/dl. He said I should start statin drug therapy to lower the risk of a heart attack or stroke and he issued a prescription for atorvastatin (Lipitor). This is troubling considering the known risks of these drugs and the fact that no science indicates that high cholesterol causes heart disease. Unfortunately, the doctor is probably just following his organization’s protocol. According to Mayo Clinic, LDL should be lower than 100 mg/dL (1).

Adverse effects of statins include cognitive and memory problems, muscle cramps, general weakness, impaired walking, numbness, and weakening of the immune system. Based only on these considerations, I will not take statins.

If you have a statin prescription, learn the benefits and risks yourself. Don’t blindly join the millions who spend over $30 billion per year to lower cholesterol for no benefit. Unless medical professionals you use can provide compelling evidence for you to take these drugs, their credibility, and the credibility of the organization they work for, is suspect.

You can easily find authoritative scientific evidence that support statements I make in this post. A great place to start is the following book that references many of the largest studies. All doctors and anyone given a statin prescription should read The Great Cholesterol Myth by nutritionist Dr. Jonny Bowden and cardiologist Dr. Stephen Sinatra.

A concerning aspect of my doctor’s recommendation is that it is based on LDL cholesterol level. Sure, statins lower LDL, but there is seldom reason to do so. There is no correlation between higher cholesterol levels and cardio vascular disease (CVD) risk. In fact, many studies show an inverse correlation between LDL numbers and risk. The chart below illustrates an example.

ldl-patient-distribution-3

This was a sizable study with nearly 137,000 data points. If LDL level matters at all, I would not want it to be at the average level of 116 mg/dL and I certainly would not want it to be less. In fact, risk CVD risk seems to increase as LDL decreases below 160 mg/dL.

Low LDL does correlate with dementia, which is not too surprising considering how essential cholesterol is for brain health. In fact, 25 percent of the body’s cholesterol is in the human brain. Statins lower brain cholesterol.

Factors known to cause CVD are…

1. smoking
2. excessive alcohol consumption
3. lack of exercise
4. obesity
5. sugar, omega-6 vegetable oils, and low fiber foods.

This information comes from the Nurses’ Health Study by Harvard University, where 82 percent of coronary events were attributed to these five factors (not LDL).

My triglyceride measures low at 45 mg/dl mainly because I avoid sugars and processed carbohydrates. Since I eat a low-carb diet, excessive glycation and resulting inflammation that comes from high blood sugar is unlikely. Factors such as these should be considered when statins are prescribed instead of dispensing them based only on LDL level. Medical protocols need to be supported by science, but prescriptions for statins based only on LDL level are only the result of a consensus of opinion.

You don’t have to look far back in history for examples of consensus of opinion not working well for advancement of health. Examples include the “artery-clogging” saturated fat myth, a calorie is a calorie, and the belief that trans fats are safe. Cholesterol myths are more complicated, but the idea that prescribing drugs for anyone with high LDL is good preventative medicine may someday be seen in the same category.

A metric that does correlate with CVD risk is triglyceride to HDL cholesterol ratio. My TG/HDL ratio is 45/66, which equates to 0.68 (low risk). Most people can keep this ratio low through a low-carb diet and exercise. By now, that’s mainstream health knowledge.

Here is an informative article with more about the TG/HDL ratio from Professor Grant Schofield:

THE IMPORTANCE OF THE FASTING TG/HDL RATIO

Statin drugs reduce the body’s levels of coenzyme Q10 (CoQ10) – an essential nutrient found in almost every cell in the body and one that is critical for heart health. In fact, the largest concentration of CoQ10 is in heart muscle. Depletion of CoQ10 may have something to do with the adverse effects of statins that involve impaired muscles.

The physician that prescribed statins for me explicitly categorized LDL as “bad” cholesterol. That’s a common thing to do, but it makes no sense. The body makes LDL because it is essential to human life. No test was done to assess whether my LDL includes high levels of the small-particle type of LDL (LDL-B) that can be easily oxidized and cause inflammation. However, the fact that my triglyceride is low is a strong indicator that the LDL is mostly LDL-A, which is not prone to oxidation and inflammation.

From High Triglycerides – How to Lower Triglycerides by Axel F. Sigurdsson MD:

Small dense LDL particles appear more strongly associated with the risk of cardiovascular events than larger particles (2,3). In the SCRIP trial, high triglyceride levels were associated small, dense particles in 90 percent of subjects whereas lower triglyceride levels were associated with larger buoyant particles in 90 percent of subjects (4).

Other indicators of my cardiovascular health include blood pressure, which measured 120/80 and my VLDL that tested at a low 9 mg/dl. My blood tests revealed no information that scientifically indicate I have unusual risk for CVD and I have not had symptoms of heart disease. Without threatening existing symptoms (like a heart attack), drugs should not be used for a condition that can be helped with diet and lifestyle.

Statins never result in significant improvement to longevity and they are toxic. They degrade health in many ways, sometimes causing death. These drugs can be useful for middle-aged men with symptoms of low HDL cholesterol and heart disease. I am at the upper end of middle-aged (60+), my HDL is not low, and I do not have heart disease so prescribing statins for me was clearly very wrong.

The medical industry generally excels in care for acute problems, but incidence of CVD continues to worsen as use of sugar, vegetable oils, and statin drugs increase. Excessive drug use that is happening now will someday be seen as a travesty. I’m sure future generations will learn to use the information that is now easily available to reverse the modern chronic disease epidemics of dementia, diabetes, and heart disease. This will happen mostly through healthy nutrition and reduction of unnecessary drug use.

 

 

 

(1) Mayo Clinic staff article: Statins: Are these cholesterol-lowering drugs right for you?

(2) JAMA. 1996 Sep 18;276(11):882-8.
A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. https://www.ncbi.nlm.nih.gov/pubmed/8782637

(3) JAMA. 1998 Jun 24;279(24):1955-61.
Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. https://www.ncbi.nlm.nih.gov/pubmed/9643858

(4) Circulation. 1996 Nov 1;94(9):2146-53.
Predominance of dense low-density lipoprotein particles predicts angiographic benefit of therapy in the Stanford Coronary Risk Intervention Project. https://www.ncbi.nlm.nih.gov/pubmed/8901665

 

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Human Diet Perspective

jnwillits - carbobydrate consumption timeline

After 2.5 million years of eating minimal sugars, grains, and vegetable oils, people are addicted to (and are suffering from) a radical new diet. Sugars and grains are ubiquitous and common foods have recently begun to include unusual amounts of heat-processed vegetable oils. Food industries, governments, and medical institutions endorse and promote this way of eating and the resulting chronic diseases have caused alarming levels of pharmaceutical sales.

Our first 1.5 million years of human diet history is omitted from the graph, although it would show the same 18 percent consumption level. For time perspective, if the history of mankind were represented by a distance of 100 meters, the last 100 years would be within the final four millimeters. If the complete 2.5 million year history were shown on the graph, the recent spike of carbohydrate eating would be so thin it would be nearly invisible. A graph to illustrate consumption of heat-processed vegetable oils would appear similar to the one for carbohydrates, except the vegetable oil consumption would be depicted as a flat line on the x-axis until modern times.

The time the graph shows is enough to make the point that our switch to eating sugar, grains, and heat-processed vegetable oils is an extreme change.

People and Carbs in the Metabolic Syndrome Era

The USDA likes pancakes!

The USDA likes pancakes!

Since the 1970’s, health institutions have advocated diets high in carbohydrates (low in fat) and carb consumption has significantly increased. The USDA recommends a low-fat diet consisting of 45 to 65 percent carbs and this is not likely to change with revisions to the 2015 dietary guidelines. I want people, especially people in my family, to know why habitually consuming this amount of carbs is unhealthy and to be skeptical of the high-carb promotions coming from institutions and the food industry. For an example of this messaging, see The USDA Likes Pancakes Topped with Fruit and a Sprinkle of Sugar. Also consider an article CSPI (Center for Science in the Public Interest) published that included…

…even for otherwise non-controversial advice, such as advice to avoid diabetes and other diseases by selecting diets high in fruits, vegetables, or whole grains.(1)

Fruits, vegetables, and whole grains are healthier than junk food. However, even ignoring issues concerning grains(2), there is much controversy regarding a high-carbohydrate diet. So I asked CSPI via Twitter:

My tweet links to the CSPI article. There hasn’t been a reply. Considering the general state of American’s health (more than 50 percent are diabetic or prediabetic) and that we have followed USDA recommendations(3), the notion that eating a low fat diet is healthy is controversial. Nevertheless, validity of the low-fat diet is the consensus of opinion among many organizations such as CSPI, ADA, AHA, and USDA. I think CSPI labels it non-controversial to dismiss other ways of eating. Of most interest to me, they have explicitly dismissed the low-carb high-fat (LCHF) diet(4).

The CSPI website describes initiatives they are working on, such as reduction of salt consumption and eliminating junk food from schools. Health profiles will get better when kids eat less junk food, but I would like to see CSPI seriously attack the metabolic syndrome epidemic in ways that will have more effect. To do that, they will need to focus on the key factors of modern chronic diseases – inflammation and insulin resistance. I believe the primary root cause of both of these maladies is habitual consumption of too much carbohydrate over the course of years. Certainly trends of metabolic syndrome are coincident with increases in carbohydrate consumption. While this doesn’t prove causation, there is convincing evidence that this problem will not be resolved until the general consumption of carbs reverts to much lower levels. CSPI is an influential advocacy group so it is unfortunate they promote the low-fat diet and dismiss alternatives that many people are discovering to be healthy(5).

Unfortunately, health professionals commonly ridicule ways of eating that do not fit low-fat dietary guidelines. Consider the following tweet that links to an info-graphic from Kaiser Permanente, which categorizes the Paleo diet as a fad. It suggests that you may have difficulty sustaining this 2.5 million year old diet of unprocessed real food and that it may leave you deficient in vitamin D and calcium. Dr. Maroon buys right into this.

Institutions and food industries use a variety of messaging to defend and promote low-fat nutrition. Modern health professionals often repeat the “artery-clogging saturated fat” phrase to advance the perception that the low-fat diet is healthy. Since this is the common view of experts, using this term gains the support of other experts, and the notion that dietary saturated fat clogs arteries is continually reinforced(6). CSPI is represented by credentialed health professionals who apparently have this consensus of opinion:

Yikes! I bring up the saturated fat issue to give an example of how health professionals work to bend the public’s perception to suit their beliefs and agendas. People are evolving and are slowly getting nutrition figured out so be wary of institutionalized myths(7).

CSPI’s categorization of diets high in fruits, vegetables, or whole grains as a non-controversial way to avoid diabetes ignores the LCHF movement. It ignores the science(8) and the experience of people who have reversed symptoms of diabetes through LCHF eating. Dismissing this is wrong and it is wrong to suggest that low-fat USDA nutritional guidelines are non-controversial(9).

Really, what’s the big deal?…

USDA's High-Carb Plate

USDA’s High-Carb Plate

A diet of fruits, vegetables, and whole grains is certainly healthy relative to many other diets so what’s the big deal? This describes the low-fat diet illustrated by the USDA MyPlate icon. Actually, the icon indicates a nearly zero-fat diet. So did I get bent out of shape over CSPI’s use of the word “non-controversial” for a good reason? To answer that, I will summarize a few facts regarding what carbs actually do. Then I will get back to why I am picking on CSPI.

The USDA nutritional guidelines recommends a diet of 45 to 65 percent carbohydrates and is therefore an extreme diet. It is extreme from a historical perspective and it is extreme because of the demands it imposes on the body. People have become so accustomed to an abundance of breads and other processed high-carbohydrate foods that they are typically not aware of how unusual it is to eat so much of this. A target of less than 20 percent carbohydrates is more reasonable(10). It certainly makes no sense to recommend that half your intake should be from a nonessential macronutrient.

Consider the quarter of the MyPlate icon devoted to grains. The USDA actively supports grain consumption and suggests making at least half of your grains whole. I disagree with the USDA’s zealous promotion of grains because even whole grains are high-carb and grains are not particularly nutrient dense(11). They recommend 410 calories of grains per day for a person that consumes 2000 calories per day. This equates to six slices of 100 percent whole wheat bread and a single slice of this has 12 grams of carbohydrates and one gram of added sugars(12). If you followed the USDA recommendation with 100 percent whole wheat, you would be consuming 78 grams of carbohydrates per day just from the grains. The body breaks down all carbohydrates into simple sugars. There are approximately five grams of sugar per one teaspoon so your body will need to process 15.6 teaspoons of sugars just from the whole wheat. Fortunately, the fiber and the more complex carbohydrates in the whole wheat slows the process, preventing the type of blood sugar spike you can get from junk food. Still, the sugar from just one slice of whole wheat bread is in excess of the body’s requirement(13) and imposes an unnecessary glycemic load, considering that less than one teaspoon of sugar is in a normal person’s bloodstream(14).

Other foods have higher concentrations of carbs. For instance, the simple sugar component of the carbohydrate in just a medium order of fast food fries is about 10 teaspoons. Dr. Malcolm Kendrick’s article, What happens to the Carbs?, is an excellent discussion of how the body processes more carbs than can be used.

None of this information proves that eating six slices of whole wheat bread a day is unhealthy. We do not know the optimum macronutrient ratio and we never will because there are too many variables that continually change (insulin resistance, level of exercise, etc.). However, what is known about the effects of excess blood sugar reinforces my conclusion that a 45 plus percent ratio is potentially damaging.

Of course, “extreme” is a matter of degree. Would you think drinking 12 ounces of Coca-Cola Classic per day is excessive carbohydrate consumption? This piles on 39 grams of simple sugars per day to process – all in excess of requirements. After one year, you will have consumed more than 31 pounds of sugar. Swapping the soda with sports drinks or “natural” fruit juices will bring essentially the same result. What if you eat six slices of whole wheat bread per day? Is this excessive? While the 78 grams of carbohydrates in the bread is converted to simple sugars, your blood sugar level will not be spiked as it is with the sugar from Coke. Nevertheless, I believe this is excessive as well. While tolerance to carbs varies, excessive habitual carb intake results in the inflammation and insulin resistance that is driving metabolic syndrome. Fat and protein do not significantly affect inflammation(15) and insulin production. Carbohydrates do. To avoid diabetes, lower the proportion of calories that require insulin production. An occasional carb binge is not going to significantly harm anyone with normal tolerance, but there are consequences.

If you do eat grains, at least follow CSPI’s advice to eat whole grains. This is important because the glycemic load from a serving of white bread is almost as much as it is for a soft drink (16 for the drink and 14 for the bread). Unfortunately, most of the grain-based processed foods that fill our grocery stores do not consist of whole grains.

The insulinogenic index is probably a better way to assess whether foods will stress your system and increase chances for diabetes. It factors in protein. fiber, and fat(16). Avocados are nutrient-dense and include a lot of fiber, making a calorie from avocado more than five times less insulinogenic that a calorie of 100 percent whole wheat. There are better foods to eat than whole grains to avoid diabetes.

You may believe that the correlation of low-fat diet and metabolic syndrome trends do not point to the cause of generally poor health. After all, health conditions have clearly been exacerbated by refined sugar consumption, mostly from sugary soda, sports drinks, and fruit drinks. These quickly metabolizing sugars result in more impact to health than complex carbohydrate foods that include fiber. Assessing nutrition is also complicated by the fact that everyone’s tolerance to carbs differs and exercise has effects as well. Low-fat diet advice is not completely to blame for chronic metabolic diseases. However, an excess of carbohydrates over a long period of time does result in

  • fatty liver disease
  • visceral fat
  • diabetes
  • obesity(17)
  • oral health dysfunction
  • inflammation (affecting cardiovascular health)
  • high triglycerides and more…

Atherosclerosis is influenced by elevated blood glucose(18) so don’t elevate your blood glucose. The only way to significantly elevate blood sugar is to guzzle carbs. I don’t think there is a reason for concern, unless your carb intake approaches or exceeds USDA dietary recommendations.

Research these issues for yourself. If everyone had an understanding of all facts regarding nutrition, the diet advice given by institutions would be of no consequence. However, people are getting information from institutions that they are believing and following and some of this advice is making them sick. The information seems believable because it is repeated over and over. Some of it is just believable anyway. For instance, doesn’t it seem logical that eating sticky saturated fat could clog your arteries? And why wouldn’t it be healthy for humans to start consuming a diet with one fourth of calories coming from grains?  The low-fat high-grain diet is enshrined in icon’s, repeated in textbooks, and it is alluded to as “non-controversial”. Medical doctors who deviate from low-fat dogma are attacked for any inconsistency or any issues that can be found. They are publicly derided and they are sometimes referred to a quacks. Watch for this and look for the evidence to decide what is credible.

Nutrition is complex and it has been afflicted with poorly executed and biased science. There are many variables and there is much that is unknown. People’s tolerance to carbohydrates varies widely and can change over time as insulin resistance changes so there is no single diet that fits everyone. It is too soon to dismiss anything just because it is not USDA approved.

jeffs-myplate-400

Jeff’s Non-USDA Approved Plate

With no sugars and no grains, what’s there to eat?

There’s lots of really tasty choices, even when you limit yourself to real, unprocessed food. The photo shows one of my plates consisting of:

  • hamburger (unfortunately not grass-fed)
  • cheese
  • mustard (no sugar in this)
  • bacon
  • pickle
  • celery
  • carrot
  • lettuce
  • tomato
  • onion

I entered the type and amounts of these foods into the USDA’s SuperTracker and clicked the Nutrient Intake Report link. From that I learned his meal is 486 calories with nine percent carbs. Had I included a white hamburger bun, calories would have gone to 606 and the carb content would have been 22 percent. A couple of years ago, I would have included the bun and sugary ketchup, skipped the bacon, and there would have been fries instead of veggies. Interestingly, if the bun was 100 percent whole wheat, calories would have been 600 with the total carbs at 22 percent. So adding a wheat bun would more than double the carbs, but there is little difference in carb content between the white bread and whole wheat. Adding the 100 percent whole wheat bun would have increased fiber consumption by three grams along with the 114 additional calories.

This is a typical dinner for me. Eating this way, I find that I am sometimes not hungry in the morning so I skip breakfast. Later in the day, after about 15 hours of fasting, I will go running and I don’t bonk. This is a common experience for fat-adapted runners. There’s no way that would have happened in my past as a carb-loading runner(19).

I think it is worth the effort to criticize CSPI because they can influence health trends positively. CSPI is a strong advocacy group that has demonstrated capability to change when it is warranted. It will be awhile before USDA reduces the grain portion of the plate icon due to powerful special interests. CSPI can help with this. Better advice for them to give for avoiding diabetes would be:

Don’t eat sugar. Don’t eat grains.

The body makes glucose as needed without dietary carbohydrates so it would be better if CSPI recommended avoiding foods that have to be ultimately processed as simple sugars. My guess is that CSPI does not follow Jeff’s Health Notes so I will invite them to comment on this via Twitter.

Some of my comments are opinions supported only by my experience, reported experience of others, and my interpretation of research. However, there is enough science regarding what carbs do to know that an average of more than 45 percent is excessive and there is much other evidence. Look around – you will find a few people from health and food industries recommending carbs, lots of people eating carbs, and lots of people burdening the health care system with chronic diseases. Long-term LCHF eaters are not participating in this.

Notes and References:

1. This is quoted from CSPI’s article, Nation’s Health Groups Oppose Appropriations Riders Aimed at Gutting Dietary Guidelines for Americans. The author probably means “and whole grains” instead of “or whole grains”.

2. See the lecture, Wheatlessness: A 21st Century Health Strategy, by cardiologist Dr. William Davis.

3. See Jeff’s Health Notes: Eating Trends Follow Guidelines and information from the CDC:

Also, we have been eating a lot of wheat during the metabolic syndrome era…

4. Jeff’s Health Notes: Nutrition Action Debunks Low-Carb Diets???.

5. The LCHF movement is supported by science, although more is needed. Passion for it is based on the stories of millions who have experienced LCHF health, including improved blood lipid metrics, weight loss, and reversals of type 2 diabetes symptoms. There is much collective experience throughout social media.

6. While cholesterol  amassed to repair an inflammation can clog arteries, dietary saturated fat does not. The 2015 Dietary Guidelines Advisory Committee made statements pointing out that dietary saturated fat is not a significant concern based on science. For instance, from their report…

…recent meta-analyses of prospective observational studies did not find a significant association between higher saturated fat intake and risk of CVD in large populations.

In some conflicting statements, the committee also noted that Americans are eating less saturated fat and they believe we should eat even less.

7. There is a need for unbiased nutrition science. The following article by Stephan Guyenet, PhD discusses the weak association between habitual saturated fat intake and blood cholesterol and the lack of science that, according to popular belief, demonstrates that dietary saturated fat is “artery-clogging”: Does Dietary Saturated Fat Increase Blood Cholesterol? An Informal Review of Observational Studies. Then there is the issue of whether you really want low cholesterol. Both total and LDL cholesterol metrics are not good predictors of mortality and low LDL is associated with risk for dementia. There is more about this in Jeff’s Basic Health Notes and Comments for the 2015 Dietary Guidelines. Also see Zoë Harcombe’s article Saturated fat & CHD in Europe.

8. A great deal of science has demonstrated effects of excessive carbohydrate intake and much more needs to happen. Groups such as The Noakes Foundation work to advance science related to metabolic syndrome. See the References section of this website and review citations provided by the referenced sources. Some of the authors of the references, such as Dr. Joseph Mercola, have been the subject of vitriolic rhetoric from people and organizations that do not agree with his views. Ignore this and objectively review the information provided and what is cited as evidence. Special agendas often result in very skewed conclusions that get published regarding nutrition. See Interesting Low-Carb Science where scientists discover they can reverse symptoms of diabetes in rats by feeding them a low-carb diet. Also see My Five-Star Rating and Comments on The Big Fat Surprise. Read the book and review the references. There is also much information that points to LCHF benefits that is from experience. For instance, Dr. Sarah Hallberg reverses symptoms of metabolic syndrome in her clinic through the prescription of LCHF, as opposed to using high-carb ADA nutritional guidelines. Her TEDx talk, “Reversing Type 2 diabetes starts with ignoring the guidelines”, is published on YouTube:

9. For my admittedly controversial views on the USDA dietary guidelines, see Comments for the 2015 Dietary Guidelines. Also see Food Guidelines Are Broken. Why Aren’t They Being Fixed? by Jeff S. Volek, PhD, RD. which states:

The excessive consumption of carbohydrates is the primary cause of obesity and diabetes—and it’s not a stretch to implicate the dietary guidelines in these epidemics plaguing our country.  

10. Jeff’s Health Notes: More About Macronutrient Targets.

11. Zoë Harcombe: ‘Healthy whole grains’ – really?!

12. The amount of carbohydrates in whole wheat bread is almost the same as the amount in white bread. There is twice as much fiber in whole wheat. A slice of 100 percent whole wheat bread includes two grams of fiber. However, there are more concentrated fiber sources, such as from avocados. One green avocado provides 20 grams of fiber.

13. As there is no nutritional requirement for carbohydrates, any amount is excessive by definition, although the extent to which carb consumption matters is widely variable. Eliminating carbs would be impractical and unnecessary. However, because our bodies produce glucose as needed from the essential macronutrients (protein and fat), I believe habitually consuming over 45 percent of your diet in carbs is extreme. This is based on known effects of elevated blood sugar and some of my own experiences with the health consequences.

14. Micheal R. Eades, M.D.: A spoonful of sugar

15. Inflammation results when the small and dense type of LDL cholesterol particles become lodged in artery walls. This type of LDL is more prevalent in people who eat low-fat high-carb diets. For a well-referenced article regarding this by cardiologist Dr. William Davis, see New Blood Test Better Predicts Heart Attack Risk. Also see Advice to follow a low-carbohydrate diet has a favorable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet, Annals of Medicine.

16. Marty Kendall: GLYCEMIC INDEX LOAD VERSUS INSULIN LOAD and PROPORTION OF INSULINOGENIC CALORIES.

17. Unless someone is extremely gluttonous and slothful, the only way an otherwise healthy person can become overweight is by habitually eating an amount of carbs that are excessive for their physiology. Few people are overweight due to gluttony or sloth.

18. See section 4.3 of Scientific Advisory Committee on Nutrition – 2015 (UK), Carbohydrates and Health.

19. Endurance athletes improve performance once they become fat-adapted.