Author’s Note: Recently I received a couple of responses to my article on cholesterol that asked some good questions and were thought-provoking. I want to share with you those questions, as well as the answers I gave to them. This is a good way to enlarge on some of the principles that I mentioned in my article in Meridian. I have chosen to break my response down into the Top Ten Medical Myths: some about statins, cholesterol, and a couple about the “hard” research behind medical claims. Best Regards, Stan M. Gardner, M.D.
First Comment:
Boy, this is quite a bit of misleading journalism. While the author of your article chose to take the antioxidant route, he failed to look at the best prospective study still running – the Framingham Study – to consider the influence of cholesterol on mortality.
I can’t speak to the other research that he quoted, but I do know that the Framingham study specifically takes into account cholesterol, HDL, LDL and triglyceride when risk stratifying a specific cardiac risk. While it is still being determined what kind of anti-inflammatory effects statins have, we know that they affect cholesterol, and in turn, lower cholesterol reduces all mortality associated with coronary heart disease.
In addition, the discussion of CoQ10 is another of the in vitro arguments that has not panned out in real research. While biochemical pathways would suggest that CoQ10 should be lower as a result of statin use, we do not find that is the case. In addition, the supplementation of CoQ10 by individuals taking statins has any beneficial effects. If the author is to suggest that the reduction of CoQ10 because of statin use causes the adverse effects noted by some patients, why does it not happen to all patients, or even a majority? The muscle fatigue and pain that are noted with some statin users is in a profoundly small percentage. Were it not so, the FDA would take it off the market.
Finally, the author has decided that it would be appropriate to cause a rush of readers to their doctors to have their high specificity CRP measured to find out if they’re going to die from a heart attack. High specificity CRP is an excellent marker for those with an intermediate risk, if as a clinician you’re on the fence about treating their high cholesterol. It has its benefits, but also has its limitations, and shouldn’t be touted as the lab test to do.
I would recommend that if you’re going to have someone write medical reports for your online magazine, that you either don’t utilize someone who appears, in my mind, to be expressing a view somewhat on the fringe of medicine, or at least have a more mainstream view to counter his. Of note, I am an acupuncturist, though I’m an MD, I dabble in osteopathy, and I promote preventive measures in my practice such as diet modification and exercise to improve health. I discourage medications unless other measures have been maximized, and I believe that Western medicine doesn’t have all the answers. However, Dr. Gardner’s article has some viewpoints that are not shared by the greater medical community, and I think that he should be a bit more objective in what he writes.
You raise some good questions and I appreciate your taking the time to write. Quite a number of other, well-designed studies support the prevailing premise that cholesterol levels relate to heart disease and mortality. However, let’s look at some other conclusions that have come out of the Framingham Study that are not so well known, as they don’t seem to fit the present day “box”:
1. Medical Myth #1: Saturated fat intake leads to poor health and short lives.
FACT: In 1992, the lead investigator of the study, William Castelli, stated that the healthiest and longest-lived people in Framingham ate the most saturated fat. (Archives of Internal Medicine, July 1992; 152: 1371-2).
My training in medical school was that saturated fats were unhealthy, and we wouldn’t live as long if we consumed them. So how does this finding fit the present perspective?
2. Medical Myth #2: People with lower cholesterol levels have a lower death rate.
FACT: Those whose cholesterol levels fell during the first fourteen years of the study had a higher death rate over the next eighteen years. This is the conclusion found in the article by Anderson, K.M. and others. (In JAMA, 1987; 257:2176-80, by Anderson K.M., et al. Cholesterol and Mortality. Thirty Years of Follow Up from the Framingham Study).
Current medical thinking is that if cholesterol levels fall, then those with the lower levels should live the longest. So why do the findings show an increased death rate in those with the lowered levels of cholesterol?
3. Medical Myth #3: Cholesterol levels are the main determining factor in “clogged” arteries.
FACT: In the Framingham Study, people under the age of 60 years who had been diagnosed with significant cardiovascular disease were examined, and then researchers looked at the internal carotid arteries of their children, the offspring had an increased thickness in their internal carotid arteries. This infers that in this group cardiovascular disease had a strong genetic component, not necessarily related to cholesterol levels. This was printed in the journal Circulation: Journal of the American Heart Association, July 22, 2003.
4. Medical Myth #4: Studies that are printed in medical journals are unbiased and complete reports based on double blind, placebo-controlled studies.
FACT: One thing is very clear to me, and that is that the studies that do not support the prevailing philosophy are not well publicized. I still maintain that because of preferential citation of supportive studies, the United States is focused on a perception of “evil” in cholesterol, blaming cholesterol as the main factor in heart disease. The same focused (or unfocused) perception ignores an equal number of studies that do not show a connection between cholesterol levels and vascular disease.
5. Medical Myth #5: Cholesterol levels are the best indicators of potential heart risk.
FACT: Although I do not advocate that people rush out to get a CRP level to assess their heart disease risk, I certainly think that a high sensitivity CRP level is a considerably better indicator of potential heart risk than a cholesterol level. This is well enumerated in Clinical Chemistry 2001; 47 (3): 403-11, entitled “High Sensitivity C-Reactive Protein: A Novel and Promising Marker of Coronary Disease,” by Ridker PM and others. In his article, Ridker also makes the comment that one half of all myocardial infarctions take place in people with “normal” cholesterol levels. I do think it’s appropriate for people to rush out and follow the complete list of suggestions I made in the article to reduce their inflammatory risk, which will reduce the risk of cardiovascular disease significantly more than getting any lab test.
6. Medical Myth #6: Claims about the value of CoQ10 do not pan out in real research.
FACT: There is an article that addresses your comments about CoQ10. This is found in the Journal of Nutritional and Environmental Medicine, March 2004, Volume 14, No.1, pp 17-28. The article is a literature review, internet search and discussions with colleagues. Their results include a long list of statin functions, including hypolipidemic, vasodilative, anti-thrombotic, anti-oxidant, anti-inflammatory, anti-proliferative, anti-coagulant functions. The authors also cite the London Dispatch on the television network CNN in January of 2002, indicating the deaths from Baycol had exceeded 100 prior to its being taken off the market. Their conclusion: several studies have reported a significant reduction in serum CoenzymeQ10 in patients taking statins. Such concern was also expressed by the International College of Cardiology at their meeting in April 2002; it was proposed that coenzymeQ10 should be considered in the prevention as well as the treatment of statin intoxication. And one last study, found in Medscape, June 22, 2004, entitled “Atorvastatin reduces blood CoQ10 levels,” stated the following: “even brief exposure to atorvastatin causes a marked decrease in blood CoQ10 concentration. . . .Widespread inhibition of CoQ10 synthesis could explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia (muscle pain), and myoglobinuria (muscle breakdown products in the urine).”
Second Comment:
I think you should not make claims that are not backed up by the AMA etc. that would lead people with heart problems to quit taking their heart meds like Zocor, alpha and Beta blockers and switch to homeopathic meds like Policosinol, Gugulipids, and chelation therapy.
I’m not exactly sure what the purpose is behind your comment on “you should not make claims that are not backed up by the AMA.” However, if you’ll permit me to climb up on my soapbox for a moment, I will address a few issues.
7. Medical Myth #7: The relative value of a research finding depends upon if it falls within the parameters which are accepted by the majority of the establishment.
FACT: One way this comment could be taken is that the majority opinion should override the opinions of the minority. This is quite dangerous. A good case in point is the experience of Ignaz Philipp Semmelweis (1818-1865). Dr. Semmelweis worked with the maternity wards in a Vienna hospital. He noticed that there were fewer deaths among the mothers attended by midwives, compared to those attended by doctors and medical students. He hypothesized that the medical students and doctors were bringing “particles” from diseased cadavers in the autopsy rooms to patients who were ready to deliver their babies. (Koch and Pasteur had not yet introduced the germ theory behind disease). He ordered that hands be washed in a chlorine solution before each examination. Mortality rates among women attended by doctors and medical students quickly dropped from 18% to 1%. This belief, or hypothesis, was ridiculed by the “majority,” eventually forcing Dr. Semmelweis‘ resignation, and he died in disgrace. The thinking of the day, by the majority of physicians, was that their hands were divinely blessed, so they could not convey disease. Even as late as 1910, when Josephine Baker, M.D., started a program to teach hygiene to childcare providers, the mayor received a petition from thirty physicians, protesting that this hygienic practice of washing hands was “ruining their medical practice by … keeping the babies well.” Today the simple procedure of hand washing would save countless individuals from disease and even death, yet it is not as widely practiced as now-proven science says it should be. Fortunately, one is no longer ridiculed for advocating physicians’ hand washing between seeing patients.
As you might recall, Galileo stated that the earth revolved around the sun, instead of the universe revolving around the earth. For this he was convicted of heresy, and imprisoned for life (even though he was right – regardless of his being right or wrong, however, he should have been allowed the ability to explore and question his theories). Independent thinkers would have not been able to make changes for the better, had they been unable to think outside of the box and look at issues with a different perspective from the “majority.” And I do not believe that today we have discovered everything there is to know about our health and the treatment and cure of disease. There is a great need for those who are willing to look at all possibilities and be open to learning from their patients’ experiences and from other cultures.
8. Medical Myth #8: Any physician practicing in the USA should strictly conform to AMA philosophy and ignore any other countries’ research.
FACT: The next way to look at your comment, is that because I’m in the USA, I am forced to conform to the AMA philosophy. Does this mean that if I lived in Germany, the Philippines, Japan, Africa, I would have to conform to AMA teachings? Or would I be forced to go along with their medical society’s majority, even if they conflict with the AMA? Or am I allowed to review the data, whichever country it comes from, and evaluate if the results will be helpful to my patients? Each country and culture has thousands of years of experience in dealing with health and medical issues. We have much to learn from all of these. The AMA does not have a corner on the best methods of treating disease, and it is wise to search out answers, wherever they may be found.
9. Medical Myth #9: “Weird treatments” that involve energy, magnets, electricity and quantum physics are unproven, controversial, and hokey.
FACT: A good way to look at this myth is to look at what the AMA (which includes the FDA, the pharmaceutical industry, and major academic medical centers) has done for medical care in the United States. Prior to 1910, much of the health care in America was practiced by people schooled in homeopathy, and in physicians’ utilizing energy devices like magnets and electricity. After the Flexner Report in 1910, the AMA systematically removed homeopathy as an acceptable health practice and outlawed the use of energy devices for healing. Physicians that persisted in using energy devices had their licenses revoked and were occasionally put in jail. It is interesting to realize that since that time, the medical profession now uses a lot of energy devices, both diagnostically and therapeutically. These include electrocardiograms, electroencephalograms, electromyography, ultrasound, just to name a few diagnostic tools that use energy as the mechanism for diagnosis. The orthopedists are using pulsed magnetic frequencies for healing of bones. Pain centers are using TENS units, which are electrical devices to reduce pain. I think it is a shame that the rule of the “majority” (AMA) outlawed these time-proven methods of healing, denying countless thousands of the opportunity to benefit from what was then outlawed but is now proven solid medicine. If you would like a well-documented book to more fully understand the suppression of information and manipulation exercised by our medical establishment, read Politics in Healing by Daniel Haley.
Oh-and one more little thing: it’s interesting how many tried and true remedies our great grandmothers advocated have turned out to have valid science behind them-they work!
10. Medical Myth #10: Dietary intake of cholesterol has a significant impact on blood cholesterol levels.
FACT: Although neither question from our readers mentions this specific “myth,” it is one which is commonly misunderstood, so I decided to include it as one of the ten. Ramsey and Jackson reviewed sixteen trials, looking at dietary control of cholesterol. They concluded that the traditionally recommended diets lower the serum cholesterol by only 0-4%. As we look at African tribes, the Masai people in Kenya, the shepherds in Somalia, and other high meat- and milk-consumptive populations, the people do not demonstrate the high levels of cholesterol as seen in the American public. Sugar intake and stress seem to be key catalysts in elevation of blood cholesterol levels.
For your information, policosinol, gugulipids and chelation therapy are not homeophathic meds.
Thanks for allowing me to address these questions! I’ll now climb down off my soapbox, at least temporarily.
