In my practice and through other work that I do I encounter a steady stream of men who are ‘concerned’ about their cholesterol. These men have turned up a ‘raised’ cholesterol on routine screening, Their doctor may have suggested that they swap cholesterol-reducing margarine for butter and cut back on cheese, eggs and red meat. However, if that doesn’t work (like it hardly ever does), the next step is to ‘go on a statin’.
I really have lost count of the number of men for whom ‘raised’ cholesterol is the only supposed abnormality in their blood markers of health as well as other measurements such as weight and blood pressure. Many of these men live what would generally be regarded as healthy lives: non-smoking with a decent diet and some physical activity thrown in for good measure. So, how can it be that so many people have so much evidence of good health throughout the body, yet quite consistently fail in this one measure (cholesterol)? What occurs to me when I see men like this is just how the ‘raised’ cholesterol sticks out like a sore thumb.
Well, one reason has to do with concept of what is termed ‘normal’? Usually, what is normal is determined by so-called ‘normal ranges’. Basically, the normal range is the range of levels of, say, sodium or thyroid hormones, seen in a ‘healthy’ population of people. The middle of the normal range normally corresponds to the average level of a substance in a population.
However, for cholesterol, normal ranges are not set in this way. The upper level of cholesterol is not represented by the upper end of the normal range in a population, but decided by panels of people who ‘weigh up the evidence’ and then set an arbitrary ‘upper limit’ of cholesterol over which, we are told, risk of heart disease is raised and efforts should be made to lower cholesterol.
Average cholesterol levels in the UK in men are about 5.5 mmol/l (213 mg/dl). The ‘recommended’ level of cholesterol is 5.0 mmol/l or lower (193 mg/dl). So, by definition, more than half of men are going to find themselves being diagnosed with a ‘raised’ cholesterol and at ‘increased risk of heart disease’, however healthy they are.
Even if one believes the conventional wisdom around ‘raised cholesterol causing heart disease’ (I don’t), then the real issue men like the ones I describe above are faced with is how much they stand to gain for taking advice to modify their cholesterol. It’s generally assumed that putting downward pressure on cholesterol is inherently good, but what does the evidence show?
Based on the best available evidence we know that taking dietary steps to reduce cholesterol by cutting back on saturated fat will not reduce the risk of heart disease, heart attack or overall risk of death, and there’s simply no evidence at all that eating cholesterol-reducing margarine benefits health. Turning our attention to pharmacological approaches we know that taking a statin (or any other drug, for that matter) will not extend the man’s life by a single day. And what of other benefits? Well, 50-100 men would need to be treated with a statin for 5 years to prevent one heart attack (in other words, only 1-2 per cent of men will benefit from treatment in terms of heart attack prevention). But let’s balance this with the facts that of these 50-100 men, one or more men will develop type 2 diabetes as a result of the statin treatment and about 20 per cent or even more of men will develop adverse symptoms such as muscle weakness, fatigue and memory loss. Others may go on to suffer from adverse effects such as liver or kidney damage.
Once we go through the numbers in this way, then most men come to the conclusion that their cholesterol level isn’t really ‘raised’ at all, and that doing something about their ‘raised’ cholesterol is very unlikely to benefit their health, and quite likely to harm it. Most determine that they can get on with their healthy lives as theY were before with no need to swallow drugs or highly-processed, chemicalised cholesterol-lowering ‘health’ foods like margarine.
Sometimes when talking to someone about their cholesterol, I ask them to ask me what my cholesterol is. Then I answer: “I have no idea, because I never have it checked.” That’s not because I take an ostrich-like stance on matters that relate to my health – it’s because the great likelihood is that knowing my cholesterol numbers would not lead to me having a different view on my health or have any bearing on how I live my life. End of.
Brian, maybe your first GP was trying to encourage you to help yourself regarding your back problem, which perhaps wasn’t the most appropriate approach….but I don’t think it’s a bad thing at all for doctors to take this position. Too many of us want ‘someone else’ to fix it for us!
I agree, but would emphasize the importance of protecting your cholesterol from rancidity. It’s actually the fats (omega-3, omega-6) in LDL-cholesterol that become oxidized – due to a dearth of antioxidant protection – that’s the problem. These oxidized fats then need to be eliminated from the body before they start sticking to blood vessels and promoting cardiovascular disease. The trick is to consume a variety of antioxidants from veggies, fruits, tea, chocolate, wine, herbs, spices, and supplements, especially around meal time to protect lipid oxidation. It also helps not to consume oxidized fats from stale food or cheap supplements, and not to overheat foods containing fat. Rather, cook on low heat in the presence of rosemary, turmeric, thyme, etc, to reduce oxidation and cancer-causing substances.
What a relief to read all that.
“…and there’s simply no evidence at all that eating cholesterol-reducing margarine benefits health.”
Well, at least there’s evidence that it’s bad for health. That has to count for something, right?
“Heart attack incidence increased with increasing margarine consumption (statistically significant) and decreased slightly with increasing butter consumption (not statistically significant). ”
“Butter vs. Margarine Showdown”
http://wholehealthsource.blogspot.com/2009/10/butter-vs-margarine-showdown.html
Stephan found that study via an excellent English doctor… 😉
I went to my GP in June because I have pain down my right leg when walking or standing – he told me to read a book “Treat your own Back”, so I left this practice and my new GPs are helping by sending me to a physio and spine consultant (I have radiculopathy) – so far so good. Then these new GPs decided I need a full health check …. new patient (I am 63). I wasn’t keen because of the stress and I thought that the pain would mean raised results on some tests. They wouldn’t listen and voila – 150/80 BP, 6.5 blood sugar (which went down to 4.61 with the HAC1 (?)test) I can’t understand the cholesterol readings (combined 8.8 ?) and they couldn’t interpret them either – but I’m not bothered about the levels. Still my GP said I could stop eating saturated fats and eat Benecol or similar and exercise more. I can’t bloody exercise because of my leg! And I don’t believe the links between saturated fats and high cholesterol and heart disease. Its stress that will increase my heart disease risk and the GPs are not helping – they just won’t listen to ME. Anyway I hope to sort out the radiculopathy soon and then I look at reducing the BP. Maybe in 6 months we can look at levels when I am not so stressed I feel that they think I am over 60 so ought to be on pills. I am so annoyed. I will not taking statins, I think that a little higher cholesterol is good at my age, and so they can stuff their pills. What happened to working WITH the patient – I never asked for the tests.
BRILLIANT!!!
I would echo Brian’s experience with GPs and testing: was told recently, at the pharmacy, that the GP had said I had to have blood test before my thryroxine prescription was renewed for another year. When I arrived surgery for required blood test, the nurse took blood and then told me it was also being tested for cholesterol. I had not asked for this test and had not been informed it was going to be carried out. I requested that the blood was only tested for thryroid levels and was met with an amazed response. It is very encouraging to read this week’s article and the common sense it contains. Thanks Dr Briffa!
Excellent post Dr Briffa, you really are a beacon of logic in the murky world of the ‘health’ industry. And wise words from Dr Domenico in his comment too.
I and others I have met have suffered severe memory loss due to statinsas well as muscle pains.
My and their doctors didn’t and don’t attribute these to statins. How many other side effects are ignored by them?
An ex-NASA doctor, Dr Duane Graveline, after going through the same experience wrote Lipitor, Thief of Memory.
Gee, memory loss? My husband is on statins, I have tried and tried to persuade him not to take them. Without telling me he stopped. Then came his 6 month diabetic check up. GP says his levels are up, he confesses he has stopped the statin. GP wags finger and explains patiently about the bad cholesterol and says he really ought to take it. So he does.
The point here is that I was becoming quite worried in the lapses I was noticing about my husband. He is a learned, erudite man who started making spelling mistakes in the Concise crossword. He was also forgetting things I had told him. I was worried because his mother had and died from Alzheimers.
I realised one day that actually he seemed much improved. Now I can’t be sure but I’ll bet it coincided with his not taking his statin. He is back on it and guess what, I can see the same pattern emerging. He has listened to me about so many things, has taken up the low carbohydrate way of eating, lost weight, had one of his diabetic meds. stopped and his BP med is stopped too. Why not his statin?
By the way, all those posts referring to Brian, I don’t see his post, has it been removed?
Doctors ignoring Patient’s reported adverse reactions to drugs should be a crime aren’t they meant to report adverse effects so that dangerous medications are not given out to the general population? The drug companies put material in the packets saying if you get these symptoms go straight to your doctor …you do that and they ignore you or fob you off ….why? what’s in it for them to not report these effects?
Brian,
Sometimes HbA1c readings can be artificially low because of haemolitic anaemia for example. 6.5 fasting blood glucose would suggest you are pre-diabetic. Do you control your carbohydrate intake both in terms of quality (glycaemic index) and quantity (less than 150g per day)?
Tuck wrote >>Well, at least there’s evidence that it’s bad for health. That has to count for something, right?<<
I thought there was consensus that transfats are bad for you and as far as I know margarine has transfats?
Sue G, some of the posts seem to have got out of chronological order – if you read them in order it may make more sense!!
Oops – sorry Sue G, I think they are out of order according to the date they were submitted – I posted mine after Brian’s original comment, but somehow his has ended up dated after mine. Weird….
Great article.
This business of gettuing your cholesterol checked, so then you can worry about it, reminds me of a story about investing in stocks v houses. You can read the price of your shares every day, so you worry about them – but who worries about the price of their house, every day? If it was quoted in the morning paper every day, you’d worry about that too…
@ Sue G, sounds like an alternative for your husband to improve memory would be to go off statins and on to coconut oil (and butter). The short and medium chain (saturated) fatty acids in both do wonderful things for the brain, and have reversed alzheimers in some cases.
http://www.youtube.com/watch?v=iScs0uzQZFk
Do a bit more googling on butter and coconut oil, and you’ll find many stories of improved brain function (and diabetes) by eating them. Remember, the fats in both are what are in breast milk – just the thing for growing brains and bodies!
33 years ago I learned in pharmacy school that the normal cholesterol level was “200+age.” In the early 80’s, after statins were considered for clinical use, “normal” was redefined to be 200 or less.
I also have a genetic tendency toward a high number of small, dense LDL particles, even on a high-fat diet. The only substance that helps that is immediate-release niacin. Niacin is also anti-inflammatory and has been shown to reduce overall mortality.
Sorry, but could someone put this into small figures. If I don’t ask, I’ll never learn !
Are all your patients with cholesterol questions men?
I understand there is no concern on mildely increased cholesterol, however what is your view on the extraoirinarily high cholesterol levels (total above 8, LDL above 5) gained by sat fat palaeo diet by the Apo E4 population? Does it need intervention? Diet or medicaments?
Since I’ve stopped Statins , my cholesterol has gone frm 4 + to 6.8. The nurse wants to put me back on them , but I don’t want to. All the side effects have stopped. Is 6.8 considered high ?