Focusing on the Cholesterol and Statin Controversy
It’s back! The supposed evils of cholesterol and the heroic use of statins to lower this pesky lipid molecule hit headlines again just before Thanksgiving. This made it a hot topic for the holiday table, at least amongst physicians.
I have been discussing this fatty topic over the years for variety of reasons which include:
1. Pleading for its necessity for important biological reasons. Cholesterol has many critical roles in our body and its functions include:
· Contributing to cellular structure
· Hormone synthesis
· Brain health and neurotransmitter signaling
· Vitamins A, D, E, and K, synthesis
· Forming bile for fat digestion and assimilation.
2. In February of 2012 the FDA (Food and Drug Administration) issued several changes to the warning labels of statin medications including:
· Increased levels of hemoglobin A1c levels (a lab measure of the average amount of sugar in your blood)
· Warning for an increased risk of cognitive impairment with treatment
· Measuring liver function enzymes at the start of treatment
· Noting that Lovastatin should not be used with antiretrovirals, antifungals, and certain macrolide antibiotics and their derivatives.
Furthermore, another warning in June 2011 was issued by the FDA via a black box warning that simvastatin, a popular statin, could cause an increased risk of muscle damage in those taking it.
3. You should be proud to be a fat head!
Recently, a top neurologist in the country, Dr. David Perlmutter, released his book Grain Brain. It made headlines and he appeared on Dr. Oz and on HayHouse Radio with Dr. Northrup. Dr. Perlmutter’s book provides evidence that gluten and excess carbohydrates, not cholesterol, are responsible for causing havoc in people’s brain. He feels that sugar and grains are major contributors to an increased risk in Alzheimer’s disease and other neurological issues.
Makes sense.
Did you know that approximately 25% of your cholesterol is located in your brain and your eyes contain approximately 60%? In fact, in 2009 it was believed that low cholesterol was linked to lowered brain function.
4. Statins may increase the risk of blood sugar issues, especially in women.
· The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial demonstrated a 27% increase in diabetes mellitus in patients taking rosuvastatin compared to placebo.
· The Pravastatin or Atorvastatin Evaluation and Infection Therapy: Thrombolysis In Myocardial Infarction 22 (PROVE-IT TIMI 22) substudy also showed that statins can worsen glycemic control on those on high doses.
This topic of lowering cholesterol seems to be a never-ending tennis match between integrative physicians and conventional physicians citing research and apparent conflicting information. Now, it’s back again.
The cholesterol guidelines published in 2001 by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was published in Journal of the American Medical Association (JAMA). However, these guidelines were updated in November by the American Heart Association (AHA), American College of Cardiology (ACC), and the original guidelines developer, the National Heart, Lung, and Blood Institute (NHLBI). These associations also issued an accompanying risk calculator. The newest guidelines were published in two cardiology journals.
These new risk factors include:
- One who has cardiovascular disease, including angina (chest pain with exercise or stress), a previous heart attack or stroke, or other related conditions.
- Adults with diabetes (either type 1 or type 2)
- LDL cholesterol levels above 190
- A 10-year risk of a heart attack greater than 7.5 percent
Many have been critical of these guidelines indicating that the new treatment guidelines will likely double the amount of people on statins to a total of 72 million people. The critics are pointing out that many of the panel members are affiliated with pharmaceutical agencies. Finally, there is concern with the flawed calculator which appears to overestimate risk factors.
An article written in November’s Holistic Primary Care: Upshots quoted a New York Times article with Dr. Streven Nissen, Chief of Cardiology at the Cleveland Clinic on this subject:
“Something is terribly wrong,” Dr. Nissen told the Times’ Gina Kolata. If doctors follow the calculator, virtually every African American man over 65 would be put on a statin without question.
Other experts argue that these guidelines may pick up those who have been overlooked.
So, what’s one to do?
I had the pleasure of receiving my monthly IFM (Institute for Functional Medicine) newsletter, Connections, this morning. It contained a truly heart-warming interview between founder Dr. Jeffery Bland and new Medical Director, Dr. Patrick Hannaway. I literally felt cozy warmth in my chest when Dr. Hannaway discussed his journey through conventional medicine. He explained that conventional medicine’s main focus is on pathology, or the study of disease. It is one medical model out of many in the world. It is the standard of care in America. However, there are many other systems of wellness with their own approaches, such as Chinese Medicine, Naturopathic Medicine, and Functional Medicine.
I feel that it’s important to practice true prevention, beyond using risk factors to prescribe more drugs to more people. This is the practice of lifestyle medicine.
I wrote about holistic heart health through modulating stress with yoga and meditation and the importance of staying connected to loved ones who are supportive.
I invite you to review them and provide your feedback below.
I have also updated my list in my latest blog at Saratoga.com
References:
Wood, S. JAMA Weighs In on CVD Guidance, Statins in Primary Prevention. Heartwire: Medscape. November 25, 2013. http://www.medscape.com/viewarticle/814960?src=wnl_edit_medn_wir&uac=146852BY&spon=34
Mercola, J. Dangerous Statins—Including Perfectly Healthy People. Mercola.com. November 17, 2013. http://articles.mercola.com/sites/articles/archive/2013/11/27/statins-cholesterol-treatment-guidelines.aspx?e_cid=20131127Z1A_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20131127Z1A&et_cid=DM34111&et_rid=350654099
West, A. Cardio-Chaos: New Statin Guidelines Cause Consternation. Holistic Primary Care: UpShots. November 2013.
