I recently saw a lady in her early 60’s who was terrified because her GP had told her that her cholesterol was high. “congratulations” I said, “that will probably help you live longer.” By the end of the consultation she left the room smiling.
A few weeks ago with a number of international researchers I co-authored a paper published in BMJ Open that concluded that not only was there no association with so called bad cholesterol and cardiovascular disease in the over 60’s but a trend to reduced reduction in deaths from all causes the higher the cholesterol. One explanation of our findings is that LDL cholesterol is involved in immune system protection against potentially fatal gastrointestinal and respiratory infections and possibly even cancer.
But even if one accepts that in those under 60 LDL cholesterol is a risk factor for the development of cardiovascular disease it’s risk has been not only been exaggerated but the drive to lower it by drug or diet as if this was the end in itself, as opposed to focussing on overall health has been entirely misplaced and potentially harmful.
As Harvard’s Dr John Abramson points out cholesterol is one of the most vital moleclues “and to think you can radically pull this out of the body and not have consequences is ridiculous. It’s such bad science”.
Other than statins no other cholesterol lowering food or drug that has come on the market has ever been proven to actually prevent heart attacks or death.
And only a few months ago Cardiologists were stunned when a 12,000 participants randomised clinical trial of a new cholesterol drug that significantly reduced the bad LDL cholesterol and increased the good (HDL) cholesterol was stopped early when it did not prevent deaths from cardiovascular disease.
In April recovery of incomplete data from a Minnesota heart study of 1957 revealed that replacing saturated fat with linoleic acid containing vegetable oils showed increased death rates despite significant reduction in cholesterol levels.
Even American scientist Ancel Keys, the architect of the original seven countries study that sanctified the consumption of dietary saturated fat and blood cholesterol as the one of the major correlative drivers of heart disease resulting in a change in dietary guidelines in the USA in 1977 and UK in 1983 and a subsequent multi-billion dollar cholesterol lowering drug industry was (according to Dr Stephen Phinney who met him in his later years) “ furious” that he couldn’t get a paper published in any major medical journal that redirected some of his earlier work. Keys realised that the juggernaut he had started had “gone off the tracks” says Phinney. Three decades after his original work Keys told the new York Times “ I’ve come to think that cholesterol is not as important as we used to think it was.”
In fact insulin resistance is the most important risk factor for heart attacks in young men. It’s implicated in the development of high blood pressure and is also a precursor to type 2 diabetes. Why do most people not know about this? Is it because there is no market to commodify this message? And the solution to dealing with it is relatively simple, cheap and dramatic. Only last week I saw a lady in her late 60’s who had been diagnosed with type 2 diabetes 25 years ago and had been on insulin injections for the past 17 years. Having read recent media reports that Type 2 diabetes is a condition of “carbohydrate intolerance” and ignoring what she’s been told for years she changed her diet and three months later no longer required the 80 units of insulin. What did you stop eating I asked her? “bread, rice, and sugar. But now I can enjoy eating cheese and butter again” she said with a beaming grin.
The management of type 2 diabetes has been upside down for decades. The perception is a chronic irreversible condition; and it is treated with drugs that cost the UK and United States hundreds of millions of pounds and dollars respectively. Although these glucose lowering medications marginally reduce the complications of kidney problems, eye disease and nerve disease they don’t have any impact on heart attacks, stroke or death. Furthermore, side effects of these medications contribute to 100,000 emergency room visits a year in the United States.
But how many patients are explicitly given this information? On the contrary as pointed out in the BMJ by GP Des Spence, part of the drug industry’s business plan for diabetes is “recruit tame diabetologists, massage them with cash, and get them to present at marketing events that masquerade as postgraduate education.”
Yet this is another symptom of a wider system failure where commercial influences on key opinion leaders who have made their careers on the basis of a flawed hypothesis will not find it easy to admit they may have got it wrong or are presenting an incomplete picture to patients. When a lot of money is flowing to their department to support their research they’re certainly not going to bite the hand that feeds them.
Maybe more scientists need to learn from Professor Stephen Hawking who proudly disproved his own theories on black holes. “people are very reluctant to give up a theory in which they’ve invested a lot of time and effort. They usually start by questioning the accuracy of the observations. If that fails they try to modify the theory in an ad hoc manner. Eventually the theory becomes a creaking and ugly edifice.”
We should embrace the evolution of science but as I tell my medical students medicine is not an exact science but more a practice of the art of probability. But when doctors have to make clinical decisions based upon biased information corrupted by commercial influence, we cannot claim to practice ethical medicine. What’s worse it that even the medical information we have is not being given to patients in a transparent way to help them to make informed decisions on whether to take a medication or undergo an operation after weighing up the benefits and risks.
Two years ago I wrote an editorial in JAMA internal medicine pointing out that it was wrong to not tell patients that inserting a heart stent for stable angina does not prevent heart attacks and prolong life especially as 88% thought they were undergoing the procedure for that very purpose. I received a supportive email from a colleague who wrote that “many interventional cardiologists would privately agree with you but find your message in public uncomfortable. There’s a whole industry of people whose livelihoods are dependent on invasive Cardiology.”
It is estimated that just having this honest conversation with patients many of which would then make a choice to not undergo an operation that carries a 1% risk of causing a heart attack, stroke or death would save US health care $864 million a year. Money that could be better spent elsewhere.
Perhaps the most sobering conclusion to medical research was reached by Professor of medicine and health policy at Stanford university John Ioannidis. He concluded in a landmark paper published more than 10 years ago that most published medical research is likely to be false. One factor included “the greater the financial interests in a given field the less likely the research findings are to be true.”
In a separate analysis of trials comparing exercise versus drug treatments Ioannidis found similar benefits on lifespan for the treatment of heart disease, rehabilitation after stroke, treatment of heart failure and prevention of type 2 diabetes.
Two weeks ago a crowd funded documentary I’ve co-produced attempting to cut through the epidemic of misinformation on diet and health had a screening in New York having originally premiered in the British parliament. In it former international athlete, Donal O’Neill and I go back to the origin of the Mediterranean diet where Ancel Keys conducted most of his research aiming discover the true secrets of longevity. In the tiny Italian village of Pioppi we find out why the average life expectancy remains close to 90. Health rarely comes out of a medicine bottle but simple lifestyle changes can rapidly improve quality of life without side effects. As our film The Big Fat Fix demonstrates a combination of eating food that confers wellness with the right type of exercise and stress reduction is not only a powerful intervention in the prevention and treatment of chronic disease but may also slow down the ageing process.
Pioneering heart transplant surgeon the late Christiaan Barnard said “I have saved the lives of 150 people from heart transplantations. If I had focused on preventative medicine earlier, I would have saved 150 million.”
It’s time for health care to incorporate lifestyle medicine- it’s time for the “Big Fat Fix”.
An edited version of this article was published in the Telegraph Newspaper on August 4th.
Interested in taking back your health then download The Big Fat Fix by clicking here! thebigfatfix.com