The lipid hypothesis
The lipid hypothesis of heart disease is, as Dickens wrote of Scrooge’s partner, Jacob Marley, dead as a doornail, yet, like Marley’s ghost, it continues to haunt us. Why? Because the idea that cholesterol causes heart disease–the lipid hypothesis–has been so frequently repeated for so many years that doctors have forgotten that it is only a hypothesis, not a fact.
In simplistic terms the lipid hypothesis is as follows:
a) cholesterol and/or fat in the diet leads to cholesterol and/or fat in the blood;
b) cholesterol and/or fat in the blood causes plaque formation in the arteries and, consequently, heart disease; and, therefore
c) cholesterol and/or fat in the diet causes heart disease.
Sounds simple enough, but problem is there is no hard science behind it. There is a bit of weak, but not fully convincing science that purports to prove a. Less science yet that proves b. Yet we’re all to believe a leads to b and, therefore, causes c.
One scientifically verified fact disproves the whole lot: only about half the people who have heart attacks have elevated cholesterol levels.
Let’s look at the above statement, which is absolutely true, in view of how we determine the causes of other diseases. We know that the measles virus causes measles–there is no doubt about it. Doctors can find the evidence of measles virus infection in anyone who has measles; and there is no instance that I’m aware of in which an individual is teeming with the measles virus, yet doesn’t ultimately manifest the symptoms of measles.
If half the time that people were diagnosed with measles they were found to have no evidence of the measles virus, and half the time they were swarming with an infection of measles virus yet never developed measles, would we still say that the measles virus caused measles? I don’t think so. Infectious disease specialists starting with Dr. Koch, the German physician who derived the eponymous postulates that define an infective disease back in the nineteenth century, have specific criteria to determine whether a specific bacteria or virus causes a specific disease.
Not so with those wedded to the lipid hypothesis as is apparent from an article from the Science section of last Tuesday’s New York Times.
The gist of the article is thus: a 51 year old male has had cholesterol levels that have hovered at around 300 mg/dl for the past couple of decades. A physician had persuaded this man to take Lipitor (a “statin”? drug) in the past, but he had experienced side effects and stopped it. Since that time all his physicians had been after him to go on some kind of “statin”? drug to get his cholesterol down. In his latest blood test, his cholesterol levels zoomed up to 380 mg/dl, so he finally agreed to go on a “statin”? if his doctor could give him some kind of objective evidence that his “arteries were actually clogging.”? His physician sent him for an Ultrafast CT scan of the heart, an X-ray type of test that can actually see the coronary arteries and determine the degree of calcification in those arteries. The more calcification, the worse the disease. After the radiologist examined the scan he declared the guy free of coronary arteries disease with his arteries clean as a whistle. (You can see pictures of his scan in the article along with pictures of diseases arteries.)
You would think that his clean arteries would have his physicians saying something along the lines of, “Well, you’re one of the lucky ones, so we’ll just watch and maybe re-evaluate a little later on.”?
Right?
Nope.
His doctor said:
“I still want you on a statin. And Burt [the radiologist] agrees. You got lucky. But you still shouldn’t walk around with those numbers.”
Remember, doctors are supposed to treat diseases not numbers. Pharmaceutical companies have succeeded in persuading most physicians that the lipid hypothesis is a fact, and that numbers should be treated. If Lipitor and other “statin”? drugs were innocuous, this zeal to treat numbers would just be an expensive chimera. But these drugs are far from innocuous. Take a look at the book Lipitor, Thief of Memory: Statin Drugs and the Misguided War on Cholesterol by Duane Graveline, M.D.
Not only can Lipitor steal your memory, it can do in your liver and cause a lot of other problems as well. Side effects of drugs are tolerable when the drug in question treats a disease, but elevated numbers are not a disease. Beware.
I was taking Krill Oil for a week and had horrible nightmares every night. So I stopped it and they went away. So I thought because I took it at night that I would start taking it in the morning that that might work….well it didn’t. I still had bad nightmares. I have read that Krill Oil breaks through the brain barrier so now I am wondering what exactly does that mean? This is very disturbing and causes me sleepless nights. I only took one Swanson’s Krill Oil 500 mgs. I don’t want to stop it because I need it to bring my HD cholesterol levels up and this seems the most natural way. What would you suggest?
Thank you so much,
Joy
The blood-brain barrier is the means that the brain has to keep substances in the blood that might be toxic to the brain from making it into the brain. Medicines that are designed to treat the brain are formulated in such a way as to be able to cross this barrier. Fatty substances, of which krill oil is one, make it across the barrier as well. Krill oil is a more potent form of omega-3 fats than fish oil, but both cross the barrier. The krill oil is just more potent. I suspect that the nightmares will subside with time. If not, or if you want to avoid them now, try switching to fish oil. Or reducing your dosage of krill oil (find softgels with a lower dose).
Anxious to hear your thoughts about JUPITER and the New Orleans PR offensive for statins.
I’ll get my thoughts up just as soon as I have some.
Cheers–
MRE
Dr. Mike,
I am also anxious to hear your thoughts on JUPITER. I was reading an article on the AP about the study.
http://ap.google.com/article/ALeqM5iQZYnx7w8_yt8cNemDDU71Et41yQD94BFG980
I found it very interesting that the person who led the study is a co-inventor of the blood test that tests CRP levels…
“One is high-sensitivity C-reactive protein, or CRP for short. It is a measure of inflammation, which can mean clogged arteries as well as less serious problems, such as an infection or injury. Doctors check CRP with a blood test that costs about $80 to have done.
A co-inventor on a patent of the test, Dr. Paul Ridker of Harvard-affiliated Brigham and Women’s Hospital in Boston, led the new study. It involved 17,802 people with high CRP and low LDL cholesterol (below 130) in the U.S. and 25 other countries.”
A little Conflict of interest?
When I heard this study on the National news last night, I could only cringe. Especially when they were talking about how many “new” patients could now be prescribed Crestor and/or other statins. Especially women. They are saying that now this proves there is a reason for women to take statins. Like they were telling women to stay away before this study!!!
I had to mute the volume when my husband came in the room because he still believes in the cholesterol hypothesis. His total chol is 156, with LDL at 71, at 50 y/0, without statins (too low for my liking). He is insisting that I get my numbers at my physical in Jan. (1st physical in 15 years, except for gyno, I only see Doctors when sick or emergency). I am going for the exam to keep him happy.
I am 39 y/o, eat low-carb (10%) protein 35%, fat 55% on average. I am curious to see my numbers, but afraid we will get into quite an argument if my numbers are “high”, since I eat differently than him, (butter, steak, eggs, liver etc.), and I am overweight, but steadliy dropping since going low carb.
Well, got a little off-subject here. Can’t wait to hear your take on the study.
Diana
My thoughts are up!
Dr, Mike-
Sorry, one more point. Why do you suppose they stopped the study early? Could it be because they would have been dying from something else if continued? Cancer perhaps? That would be my guess.
Diana
Or diabetes. The group taking Crestor developed diabetes at greater rates than did the group taking placebo.
Hey Dr. Mike,
Great article. I have been reading up on the lipid hypothesis ever since I was diagnosed with high cholesterol.
You see, I am a healthy 31 yr old man who maintains a reasonable diet (5’10″ 175lbs). I try to stay away from Trans and Sat Fats and I also try to stay active. However, my doctor wants to put me on statins because of my cholesterol. My HDL is 55, and my LDL was around 140 if I recall correctly. I can’t remember what my triglyceride levels were at.
The trouble is, my parents both have high cholesterol and warn me about statins because of the muscle soreness they encountered. Now, however, I’m EXTREMELY paranoid about my arteries slowly being clogged. Is there any advice you could give me? Any encouraging words? I’m not on any medication, and like I said (other than the high cholesterol) I’m strong and healthy.
Just do a search in the search function on ‘statins’ and you’ll find plenty to keep you reading. The short answer is that if you are male and under 65 (which you are) and have never had a heart attack, there is no evidence that taking a statin will increase your longevity. If you haven’t tried a low-carb diet to deal with your cholesterol, that would be the first step I would recommend.
I will give the low-carb diet a shot. BTW, I found my Lab Results. Is there any area I should be more/less concerned about?
Triglycerides – 60mg/dl
Cholesterol, Total – 241 mg/dl
HDL Cholesterol 48 mg/dl
LDL Cholesterol 181 mg/dl
Total Cholesterol/HDL Ratio – 5.0
Thyroid Stimulating Hormone – 2.151 mU/L
Thanks for the quick response!
Are we living the last days of the Lipid Hypothesis?
http://www.ncbi.nlm.nih.gov/pubmed/19081406
http://download.journals.elsevierhealth.com/pdfs/journals/0002-8703/PIIS0002870308007175.pdf
http://astute.cardiosource.com/2007/vposters/pdf/275_Fonarow.pdf
http://www.cholesterol-and-health.org.uk/hdl-ldl-2.html
We can only hope. But as long as there are lipid-lowering drugs to sell, the lipid hypothesis will have legs.
Viruses don’t cause disease, neither do germs, bacteria, parasites or fungus. They can only cause harm if the internal environment supports their existence and promulgation.
Pasteur got it dead wrong, and admitted it on his deathbed. Antoine Bechamp was the real genius, but he was not lauded by European aristocracy like Louis was.
So we live in the germ theory paradigm. Fiction.
I realize I’m very late to the game here, but according to http://www.answers.com/topic/cholesterol-high, the FDA says half the adult population has “high cholesterol”. If, in accordance with Dr. Eades statistic, half of the people who have heart attack also have “high cholesterol”, this means that cholesterol is effectively irrelevant in predicting heart attacks.
Interesting.
Sara at last someone who understands the point I was making. BTW it’s not much use saying statins treat a number not a disease; hypertension is a number as well (well 2 numbers). So is high blood sugar. Neither usually gives symptoms. Is it being suggested we ignore high blood pressure and high blood sugar?
Fred, that’s not my point at all. What I was saying is that unless the 50% of the general population who has high cholesterol and the 50% of the general population who have heart attacks are the same 50% (which they are not, because only 50% of people who have heart attacks also have high cholesterol), the relationship between high cholesterol and heart attacks is likely spurious, not causal. It proves nothing about cholesterol causing heart attacks.
Sara yes that’s right. I was just addressing another issue as well Fred
Dear Dr. Mike, I’m a plastic and reconstructive surgeon practicing in Chicago, and I also write a blog on my website which discusses many different things most of which are not related to plastic surgery directly, but I’m trying to achieve a life well lived. I think in our current society, most of us don’t live by the philosophy, life will live but rather we rely on who has the most toys wins, and that translates into making money being skinny being popular and all the vacuous accoutrements of this lifestyle. I think all this numbers jockeying with the lipid hypothesis is simply an extension of that, in addition it makes an enormous amount of money on behalf of pharmaceutical companies or products that may ultimately be very harmful. After all we always have to remember as doctors that we as humans have been around with our doctors and pharmaceutical companies and hospitals for at least 99% of our existence on earth. Mother nature in short doesn’t make that many mistakes if any at all. That’s why I look to nature to find answers, and I think science but is well done can help us unlock some of those mysteries. I appreciate your blog very much because I myself, am very concerned that we are missing the point in Western medicine about what health and beauty and fitness are all about, they’re about feeling good at living well. I ran across the movie by Fat-Head by Tom Naughton, and I wrote a review on it on my blog. I have subsequently looked for resources to discuss the lipid hypothesis, and also really try to expose the hidden incentives and what I feel is the politicized approach to health that is all too common in Western medicine. You have an excellent blog, and intend to link to your blog from my blog, and if you would like to write a short blurb about the lipid hypothesis as a guest blogger that would be fabulous and I would appreciate that very much.
Hi Dr. Ostric–
I’m flattered to be asked, but as you can see from the limited posting I’m doing on my own blog, time is at a premium for me right now. I can’t find the time to write the many posts I’ve got planned for this site, so I can hardly commit to writing for others. Thanks much, though, for the request. If things ever settle down for me in my new day job as an appliance salesman, I’ll maybe have time to write for others. But until then, I can’t do it. Feel free to excerpt any of my posts whenever you want, just be sure to link back to this site and give me credit.