Monday, January 16, 2017

Discussing The Cholesterol Controversy

Warning: High Cholesterol!  Due to its long-standing association with heart disease, the leading cause of death in the United States according to the Center for Disease Control, the emotional response to finding out that your cholesterol levels came back abnormal has become increasingly frightful over the years.  Basically labeled as an artery-clogging destructive force, cholesterol has been argued for four decades as something to keep as low as possible, even resulting in a push in recent years for cholesterol-lowering drugs, primarily a classification called statins, to be taken proactively in ages as early as pre-teen to prevent heart problems.

However, there is a lot of controversy surrounding the cholesterol theory of disease and the ever-increasing recommendation to take statins and, with the controversy amplified by the recent changes in guidelines which will potentially raise the total number of American adults on statins to above 50 million, it is time to put the theory and the medications so frequently prescribed as a result of it under the microscope. 

Fascinating, is it not, how easily one train of thought can become the dominant school of thought?  Science, especially of the medical-variety, can be a tricky beast.  Sometimes one study can be the catalyst for a mindset toward a health problem that yields a standard protocol adhered to almost religiously by conventional physicians, even in the face of strong opposition from others who posit the original study’s conclusion is questionable to outright incorrect.  Such has arguably been the case with the cholesterol theory.  Decades ago, a pervading medical hypothesis was born of a study that linked high cholesterol levels to heart disease and has served as the basis for the modern proliferation of statin-recommendations even amidst increasingly intense scrutiny regarding the merits of both the hypothesis itself and the study that helped construct it.  

Part of the reason for skeptical inquiry is the vital role that cholesterol plays in the body.  Cholesterol is used for a wide variety of purposes, from creating cell membranes to producing hormones, digestive acids, and vitamin D.  The importance of cholesterol could perhaps be summed up best by saying that, without it, human life would not be possible.  So, how could considerably lowering it be a net positive?

When the debate about the cholesterol theory of disease got louder, the dialogue among the supporters then shifted to include the now-classic differential between HDL and LDL; that HDL is the “good cholesterol” and LDL is the “bad.”  For clarity, HDL and LDL stand for high or low-density lipoprotein, which is a vehicle that carries certain substances through the bloodstream.  Neither HDL nor LDL is an actual type of cholesterol, mind you, but rather both are carrier-proteins that transport it.  HDL facilitates the removal of excess cholesterol from the bloodstream and takes it to the liver, while LDL takes cholesterol from the liver and through the bloodstream for distribution to cells; both are very important for normal human biochemistry.  The cholesterol disease theory links high levels of LDL to cardiovascular events (i.e. stroke and heart attack) and adamantly supports keeping it as low as possible, while other research confirms that high levels of LDL support, among many things, the health of the nervous system and the general functional capacity of the body and that chemically-lowering it only serves to trigger a series of adaptations that hurt the body in the long run. 

Confusing, right? 

One of the flaws in our healthcare system is its dependence on drawing generalized conclusions from research about the minutiae of something so complex as the human body which, on average, contains 75 trillion cells that perform upwards of 200,000 chemical reactions every split second; naturally, there are going to be conflicting sets of data when studying a biochemical rubix-cube.  Accordingly, there is a need for careful interpretation of research and to perhaps take findings about more intricate matters – especially those that go against logic and the basic understanding of physiological facts – with a grain of salt until further research, preferably reviewed by peers without a financial conflict of interest, can reproduce the results time and again.

Cholesterol might well be a hallmark example of caution not being exercised when the original research drew its debatable conclusions, which slammed hard into the logic that lowering a factually vital component in the human body’s assembly line could do far more harm than good.  The theory stimulated by the original study created a panic, which rather quickly manifested itself into the propagation of processed foods engineered to contain less cholesterol and the instigation of the statin drug-craze.  Statistically, it has not made people healthier to lower their cholesterol, as heart disease is more prominent than ever, as are rates of obesity (see professed foods), diabetes, and nutritional deficiencies from not eating foods plentiful enough in cholesterol.

Meanwhile, statins are a $29 billion industry infamous for their horrific and very common side effects.  Crestor, for instance, is commonly known to cause joint and muscle pain, headaches, dizziness, and higher liver enzyme counts.  The laundry list of less common (reported) side effects is vast and even includes the onset of type 2 diabetes; one particular study, a landmark trial in fact that ten years ago helped expand the use of statin drugs, showed a 25% increased risk of new onset diabetes in the treatment group!  The new drugs rising to the forefront in the aftermath of the statin controversy are being shown to be far riskier in terms of the potential side effects.

The bottom line is that the cholesterol theory of disease is flawed, its claims do not hold up against thorough inspection, and it defies the natural law of life that states clearly the important role that cholesterol plays in basic human body function.  As for statins, it would not be altogether unfair to label them as toxic.

We have reached the moment in the history of healthcare when it has become imperative to re-evaluate our near half-century tendency to treat the human body like the test tube for a science experiment.  These “landmark” studies that support the use of wildly popular drugs like statins are paper thin to the point that it is quite easy for other scientists to poke many holes in them.  When a medication-type so prominently endorsed then gets directly connected in other studies to actually increasing the risk that it professes to lower as well as accentuates the risk of other major issues like osteoporosis, cancer, kidney failure, and brain disease, then it calls into question the philosophy and practices that have steered the United States to its currently poor standing in healthcare as compared to the rest of the world. 

Thinking good things for you,

Dr. Chad

Sources: The National Institute of Health, MIT, New England Journal of Medicine

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