Originally posted by Dr. Davis on 2016-05-23
on the Wheat Belly Blog, sourced from and currently found at: Infinite Health Blog.
PCM forum Index of WB Blog articles.

Statin scare

It is shocking that so many people are bullied by doctors into taking statin cholesterol drugs: “The evidence is overwhelming: statins save lives.” “You’re a walking time-bomb. I can’t be responsible for your safety if you don’t take it.” “Your cholesterol is so high that you could die of a heart attack any time.” I’ve even heard of many patients being “fired” by doctors because of a refusal to take the prescription for Lipitor, Zocor, Crestor, or other drug.

Why such strong-arm tactics? Several reasons:

• People are given the wrong diet, a diet—reduced in total and saturated fat, increased “healthy whole grains”—that causes inflammation/rise in c-reactive protein (CRP), a drop in HDL (“good”) cholesterol , rise in triglycerides (sometimes dramatic), and an explosion of small LDL particles, all witnessed on the standard cholesterol panel as low HDL, high triglycerides, and higher LDL cholesterol (though under-representing the full magnitude of rise in small LDL particles), as well as higher fasting blood sugar, higher HbA1c, higher blood pressure. These metabolic distortions do indeed increase cardiovascular risk, though not for the reasons most doctors think. This is interpreted by most doctors as reflecting your bad dietary habits and/or the uselessness of diet.
   
• The clinical studies purporting to show 25-50% reduction in cardiovascular risk do nothing of the sort. The real benefit is around 1-3% reduction—measurable but small (and not in all groups of people, with small benefits confined mostly to people who have had a prior cardiovascular event). In other words, doctors perceive around 25-fold more benefit than there truly is. This is because studies (nearly all funded by the drug industry) perform a statistical sleight-of-hand by reporting something called “relative risk’ that misrepresents and exaggerates the real benefit (a topic for future discussion).
   
• They are “treating” either total cholesterol, which is a crude marker of cardiovascular risk in large populations but virtually useless when applied to assessing the risk of an individual, or LDL cholestrol, a calculated—not measured—value. Under the best of circumstances, calculated LDL cholesterol is an unreliable, imprecise marker for cardiovascular risk. Introduce physiological changes such as grain/sugar elimination or fish oil supplementation and dramatic changes develop in the composition of blood lipoproteins (fat-carrying proteins) that make the equation to calculate LDL cholesterol even more unreliable, in fact wildly unreliable. You can witness the unreliability of calculated LDL cholesterol when you perform a superior method of assessing cardiovascular risk, such as an NMR lipoprotein panel. Calculated LDL cholesterol might be, for example, 160 mg/dl—fairly high—but really be only 1000 nmol/L, the equivalent of an LDL value of 100 mg/dl—the calculated value is off by 60%.

Throw on top of this the fact that a third of practicing physicians are self-admitted control freaks and perhaps it should come as no surprise that people are so commonly bullied into statin—and other—prescriptions and medical advice.

Here’s a better way to view statin drugs and the reduction of cardiovascular risk. If you eliminate wheat/grains and sugar, restore vitamin D status, supplement fish oil for omega-3 fatty acids, correct iodine deficiency and obtain ideal thyroid status, restore magnesium, and cultivate healthy bowel flora, i.e., the Wheat Belly Total Health strategies:

• Small LDL particles, the most common cause for heart disease, are dramatically reduced or eliminated
   
• HDL cholesterol increases dramatically, rising from, say, a high-risk level of 35 mg/dl, to a healthy level of 70-90 mg/dl over time
   
• Triglycerides plummet. It is not uncommon for a value of 350 mg/dl to drop to 45 mg/dl, an 87% reduction
   
• Total cholesterol drops (though can also rise since HDL rises so much—yet another reason why total cholesterol is worthless: it can go up but reflects the contribution of rising HDL, a good thing)
   
• Blood sugar, HbA1c drop
   
• Blood pressure drops
   
• Inflammation/CRP plummet. CRP levels of zero are typical. (And, no, you do not need high-dose statins to reduce CRP, as some statin manufacturers will argue.)

The basic lipid panel, as well as an advanced lipoprotein panel, are transformed with these lifestyle changes, reflecting reduced cardiovascular risk—without statin drugs.

So the real question with statin drugs becomes: Is there any incremental benefit to statin drugs over and above the benefits achieved with these lifestyle changes that dramatically transform cardiovascular risk markers? If benefit in people following the wrong diet is 1-3%, then it is likely that the benefit to people following the right diet and lifestyle is far less, perhaps zero.