Cholesterol Part 4: The Conventional Wisdom

 

In the past when doctors saw heart disease, they saw cholesterol. Literally. Autopsies would show that the arteries of those that had suffered form heart disease had become plaqued and blocked with the yellow fatty substance. In addition, research (questionable research which we will discuss in a later post in this series) showed a strong relationship between blood cholesterol levels and heart disease.

As cholesterol was clearly causing all the problems, reducing our intake of dietary cholesterol would reduce heart disease. We created nutritional guidelines that vilified cholesterol and the foods that contained it (e.g. foods with high saturated fat content).

Accordingly, when you look at a standard blood panel you will see that the recommended range for total cholesterol has an upper bound, but not a lower bound, implying that you can have too much but not too little cholesterol, and that none at all would be just fine! (Remember: cholesterol is essential for normal cell function and for creating Vitamin D and for creating our sex hormones.)

Today if you surveyed members of the public on the optimal amount of cholesterol, the most common answer would probably be “none”.

The standard procedure for anyone who has, or is suspected as of being at risk of, heart disease has three parts: general advice, nutritional advice, and pharmaceuticals.

The general advice is advice that applies to almost any scenario: smoke and drink less, eat less fast food, exercise more. I have no disagreement here.

Nutritional advice from the American Heart Association is to eat lots of fresh fruit and veg, fish and poultry rather than beef and pork, use “low-fat” dairy, fibre rich whole grains, minimise (below 5% of total calories) saturated fat intake, and use non-tropical vegetable oils. There is plenty to disagree with here, but again, I’ll leave that for later.

The final part (although often the first step) is to put the patient on a class of pharmaceuticals known as statins. Statins block cholesterol production in the liver. The most famous brand is called Lipitor (indeed Lipitor is the most successful pharmaceutical in history). Statins are prescribed to men, women and children, and to people with and without heart disease. It has also been suggested that statins be added to the water supply, like fluoride. The suggestion came from a physician in the UK called John Reckless (no doubt pronounced “wreck-ils”).

The conventional wisdom views statins as a “no lose” treatment: lowering cholesterol is always good so why not put the patient on statins, even if they only have a minor risk of heart disease? As we will see later, that is indeed a reckless position.