The cholesterol myth
huffingtonpost.com
huffingtonpost.com
For example, he believes that Aspartame is surely a deadly neurotoxin that EVERYONE uses daily: http://www.huffingtonpost.com/dr-mercola/aspartame-health-ri... And also, pasteurized milk is surely bad, right? http://www.huffingtonpost.com/dr-mercola/dairy-free-avoid-th... (nevermind the other issues at play!) (and milk in general is a deadly cancer-causing toxin! http://articles.mercola.com/sites/articles/archive/2000/07/3...)
This guy has some extremely fringe and poorly supported claims, has a vanity domain name offering health advice, and sells health products direct over the internet (including known scams like Acai berry extract, "bioTHIN", and even a line of "healthy cookware!").
In other words, he has all the red flags of a Kevin Trudeau that hasn't been caught yet. He's selling magic light lamps (http://products.mercola.com/himalayan-salt/himalayan-salt-la... ) for pete's sake!
I just wanted to get the word out: Dr. Mercola is not a good source for ANY health advice. He's not even a real doctor, he's an Osteopath.
I had a D.O. as my primary care physician for a few years, and he seemed just like other doctors: oh, look, you're sick. Here's a prescription. I'm not sure if that similarity is exactly a recommendation, but there it is. :)
1) The author is crazy and shouldn't be trusted.
2) Most of what he says in this article is accurate.
Stopped clocks, and all that. So, if you're on statins please do look into their actual effectiveness--especially their impact on overall mortality statistics, not just coronary heart disease. But you probably don't want to go looking to this guy for that information.
Because THEY are out to get YOU, and only HE stands in the way to stop them, by selling you thing which are "not intended to diagnose, treat, cure or prevent any disease."
Then this caught my attention:
> Address your emotional challenges. I particularly love the Emotional Freedom Technique (EFT) for stress management.
Curious about what that was, I googled it and ended up getting an overview from wikipedia (http://en.wikipedia.org/wiki/Emotional_Freedom_Technique):
> Emotional Freedom Techniques (EFT) is a form of alternative psychotherapy that purports to manipulate the body's energy field by tapping on acupuncture points while a specific traumatic memory is focused on, in order to alleviate a psychological problem.
Further reading makes that technique appear more and more pseudoscientific to me. I realize that advocating pseudoscience in one respect doesn't mean he's advocating it in another, but it does not engender trust.
Edit: more on this author: http://en.wikipedia.org/wiki/Joseph_Mercola http://www.quackwatch.com/11Ind/mercola.html
Vitamin D decreases heart disease? Cholesterol + Melanin + UV radiation = Vitamin D. So not only does vitamin D decrease your cholesterol, it also strengthens our immune system, which can actively remove plaque from our arteries.
Low cholesterol diets are dangerous for many reasons, mainly because cholesterol is a key element in synthesizing myelin. Myelin is the insulation on nerve cells, which is why women should never be on cholesterol-reducing drugs while of fertile age and will cause a fetus to develop no viable nerve cells causing still birth or mental development problems.
Similarly, children shouldn't be on low-cholesterol diets until about 25 (when mental development -relatively- stops) or they're at risk of developing serious conditions. Sunscreen again should probably be avoided unless they're going to get way too much sun.
Not to detract from your possibly researchable argument but A) the ozone layer is getting thinner and thinner and B) the people buying the sunscreen are not necessarily the ones getting skin cancer.
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Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants.
"This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up."
http://www.ncbi.nlm.nih.gov/pubmed/20585067
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Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database
"Based on the 20% threshold for cardiovascular risk, for women the NNT with any statin to prevent one case of cardiovascular disease over five years was 37 (95% confidence interval 27 to 64) and for oesophageal cancer was 1266 (850 to 3460) and for men the respective values were 33 (24 to 57) and 1082 (711 to 2807). In women the NNH for an additional case of acute renal failure over five years was 434 (284 to 783), of moderate or severe myopathy was 259 (186 to 375), of moderate or severe liver dysfunction was 136 (109 to 175), and of cataract was 33 (28 to 38). Overall, the NNHs and NNTs for men were similar to those for women, except for myopathy where the NNH was 91 (74 to 112)."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874131/
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Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy: a critical reappraisal.
"The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors."
http://www.ncbi.nlm.nih.gov/pubmed/20585068
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Effect of the magnitude of lipid lowering on risk of elevated liver enzymes, rhabdomyolysis, and cancer: insights from large randomized statin trials.
" Risk of statin-associated elevated liver enzymes or rhabdomyolysis is not related to the magnitude of LDL-C lowering. However, the risk of cancer is significantly associated with lower achieved LDL-C levels. These findings suggest that drug- and dose-specific effects are more important determinants of liver and muscle toxicity than magnitude of LDL-C lowering. Furthermore, the cardiovascular benefits of low achieved levels of LDL-C may in part be offset by an increased risk of cancer."
http://www.ncbi.nlm.nih.gov/pubmed/17662392
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Statins and risk of polyneuropathy
"Long-term exposure to statins may substantially increase the risk of polyneuropathy."
http://www.neurology.org/cgi/content/abstract/58/9/1333
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Relation between cholesterol levels and neuropsychiatric disorders
" It is shown that low cholesterol levels in serum are associated and related to different neuropsychiatric disorders. Lowered cholesterol levels seem likely to be linked to higher rates of early death, suicide, aggressive and violent behaviour, personality disorders, and possibly depression, dementia and penal confinement among young males. Further studies are needed to confirm the evidence currently available and to relate more accurate diagnoses with hypocholesterolemia."
Yet when I first opened my medical practice in the mid 80s, cholesterol, and the fear that yours was too high was rarely talked about. Somewhere along the way however, cholesterol became a household word -- something that you must keep as low as possible, or suffer the consequences.
Yes, between the 1980s and now, dozens of clinical trials have been completed showing a dose-response relationship between LDL-cholesterol and risk for myocardial infarction. This is what changed "along the way."
You are probably aware that there are many myths that portray fat and cholesterol as one of the worst foods you can consume. Please understand that these myths are actually harming your health.
What is true is that, for a typical American diet, ~70% of the cholesterol in your body is produced by your body. The actual uptake of cholesterol per se is, truly, not thought to be that important. Diet more broadly, however, is important, since your diet supplies your liver with the raw components for cholesterol synthesis. Diet matters. Genetics matter. ~50% of the population variability in cholesterol levels is due to genetic factors, and ~50% is due to genetic factors.
In addition, the AHA updated their guidelines in 2004, lowering the recommended level of LDL cholesterol from 130 to LDL to less than 100, or even less than 70 for patients at very high risk. In order to achieve these outrageous and dangerously low targets, you typically need to take multiple cholesterol-lowering drugs. So the guidelines instantly increased the market for these dangerous drugs. Now, with testing children's cholesterol levels, they're increasing their market even more.
These are evidence-based guidelines, not wantonly chosen. Again, there is a dose-response relationship between LDL-C and risk for vascular disease. The lower your LDL-C, the lower your risk of vascular disease will be. The author presents no evidence of harm from having an LDL-C of 70, nor am I aware of any evidence suggesting so.
No physician that I know routinely worries about total cholesterol, and furthermore a high TC is almost always caused by high LDL-C, so I see this as a red herring.
Notice please that LDL and HDL are lipoproteins -- fats combined with proteins. There is only one cholesterol. There is no such thing as "good" or "bad" cholesterol.
Agreed. There are good and bad lipoproteins; it's not so simple for HDL, but most evidence suggests that LDL - especially small, dense LDL particles - is harmful at most concentrations. Really, this quote from Ron Rosedale seem completely reasonable to me.
Cholesterol is a vital component of every cell membrane on Earth. In other words, there is no life on Earth that can live without cholesterol.
This is trivially true, but meaningless. Water forms 70% of your body. This doesn't mean that you can't kill yourself by drinking too much water (acute hyponatremia --> brainstem herniation, anyone?).
If your cholesterol level is too low you will not be able to use the sun to generate sufficient levels of vitamin D.
But wait, I thought we just established that cholesterol != lipoproteins? If so, there should be no problem with driving down LDL-C to very low levels. More seriously, there must be some empirically-identifiable cholesterol level below which you fail to generate vitamin D. I suspect that level is impossible to achieve, and therefore think that this is also a red herring.
Additionally, it provides some intuitive feedback that if cholesterol were so dangerous, why would your body use it as precursor for vitamin D and virtually all of the steroid hormones in your body?
This is silly. Why, if oxygen is dangerous, do we have an electron transport chain? Let's not get teleological up in here.
Sally Fallon, the president of the Weston A. Price Foundation, and Mary Enig, Ph.D, an expert in lipid biochemistry, have gone so far as to call high cholesterol "an invented disease, a 'problem' that emerged when health professionals learned how to measure cholesterol levels in the blood."
We also invented myocardial infarction at the same time, I guess.
And one meta-analysis of over 41,000 patient records found that people who take statin drugs to lower their cholesterol as much as possible may have a higher risk of cancer[...]
True. But others show the opposite (say, for prostate cancer http://www.webmd.com/prostate-cancer/news/20100628/statins-m... ) and people who look at the balance of the evidence feel that it's not clear because the studies so far haven't really been designed to interrogate that question. http://www.ncbi.nlm.nih.gov/pubmed/20099992
I'll try to continue with the rest of this long article later.
Though he makes some true statements, I feel that his thrust is misleading, and I'll plan to expand on this in another post. For example, you do need cholesterol to transport fat-soluble vitamins (K,A,D,E) - but the amount of cholesterol that you need is so extremely miniscule that there is no way, short of a Mendelian lipid disorder, to get your cholesterol low enough to worry about vitamin transport.
This article amounts to saying "cholesterol is not always bad" (true) and "all of your cells need cholesterol" (true), therefore "most cholesterol is good for you" (probably false), and "don't try to lower your cholesterol using modern medicine" (too absolute a statement for me to buy).
My take?
1. Physicians do need to question what they learn about medicines and their actual uses/usefulness. They need to avoid the temptation to latch onto medical zeitgeists and bandwagons, instead thinking through what they know and don't know about drugs they prescribe.
2. Skepticism is good, but it needs to be responsible skepticism. Especially with regards to complex medical issues, honesty and humility (not pre-conceived notions) are most important.
It's not clear why, say, intestinal inflammation would lead to an increase in cholesterol, and I'm not aware of evidence suggesting that it does so. Perhaps it does, but the research isn't there yet, and from a clinical standpoint it's not used.