Measuring Cholesterol is Nonsense
Jeffrey I. Barke, M.D.
Board Certified Primary Care
First, a disclaimer – the opinions provided here are not intended as medical advice for any individual. Always check with your own physician before deciding to adopt any of the ideas or suggestions presented here.
For years now, we have been misled to believe that eating saturated fat leads to elevated levels of cholesterol which, in turn, leads to heart disease. This pattern was first suggested by Ancels Keys as a result of his 1958 landmark “Seven Countries” study. But Keys, unfortunately, cherry-picked data from the study to conclude that there was a correlation between dietary saturated fat and heart disease.
The problem has been that Keys and others have never pointed out that correlation is not causation. The result has been a widespread substitution of sugar for fat in diets around the world with disastrous results: Increased obesity, a rise in type 2 diabetes, and no reduction in heart disease. Sugar producers, of course, were happy to perpetuate this false sugar-for-fat narrative. In fact, the sugar industry paid scientists to push this falsehood.
In our world, that which gets rewarded gets repeated. A class of medicine called statins reduces the cholesterol made by the liver and measured in the blood. The statin industry has become a multi-billion-dollar business, with Pfizer and Merck among the leaders. Atorvastatin (the generic version of Viatris’s statin drug, Lipitor) is the most prescribed prescription drug in the United States.
You can only imagine the incentives that Big Pharma offers to the medical profession to maintain the falsehood that lowering cholesterol is beneficial. Their outside law firms all charge more than $1000 per hour for principals; their advertising budgets are astronomical — Pfizer, alone, spends nearly $3 billion annually. The pharmaceutical lobby is by far the biggest in Washington, DC - far larger than the oil industry or the teachers’ organizations.
But wait, you say, all the statins are off-patent and there is not much profit in generics! Yes, true, but now there is a brand-new class of patented cholesterol-lowering meds in the marketplace, and being pushed even harder than the statins. These are called PCSK9 inhibitors — a medicine far more powerful than the statins in reducing cholesterol. And, by the way, they are much more expensive than the statins as well.
Of note, too, the majority of scientific research in the medical field is funded by the pharmaceutical industries. Does conflict of interest come to mind?
The FDA requires an information insert with each package of medicine sold. Rosuvastatin, one of the most popular statin medications, lists the following potential side effects of taking the medicine:
Myopathy and Rhabdomyolysis (muscle damage)
Immune-Mediated necrotizing myopathy (muscle damage)
Hepatic dysfunction (liver disease)
Hematuria (blood in urine)
Increases in HbA1c and fasting glucose (elevated blood sugar)
Then in post-marketing studies (patient experiences after the drug has been approved and is being used), drug companies have reported the following additional problems:
Thrombocytopenia (low platelet count)
Fatal and non-fatal hepatic failure (liver disease)
Arthralgia (joint pain)
Peripheral neuropathy (nerve pain)
Cognitive impairment (brain fog, memory problems)
Gynecomastia (enlarged breasts in men)
Interstitial lung disease (lung disease)
Given the potential danger of these serious side effects, shouldn’t there be a significant benefit to the patient as a result?
First note that there are two types of risk: Relative risk and absolute risk. We often hear how a statin drug can reduce the risk of heart disease by about 35%. But, that is a relative risk. Let’s say 2,000 patients are studied — 1,000 take the study medicine and 1,000 take a placebo. This hypothetical study might then show that three people in the placebo group died versus only two in the treatment group. You could then accurately state that the medicine reduced the risk of death by 33% (2 instead of 3).
What we are not told is that in order to achieve that 33% reduction in risk, the 1000 people have to be treated with the drug for 5 years to benefit 2 individuals. Put another way, it takes 500 people treated x 5 years to potentially benefit 1 person. This is known as the “number needed to treat” or NNT. It also means that the other 499 people in the study group received no measurable benefit during the five years, but were nevertheless subjected to the potential side effects. In fact, recent studies have shown that up to 50% of statin users stop the drug during the first year because of the side effects.
The studies that allowed the FDA to approve statins are in the ballpark of the hypothetical example above. The studies are funded by pharmaceutical companies that look to profit from the drug under study, are summarized by researchers paid by the pharmaceutical companies, and then published in journals [New England Journal of Medicine, Journal of the American Medical Association (JAMA), and The Lancet] that are supported by advertising from those same pharmaceutical companies.
There are also multiple studies that show a reverse correlation between cholesterol and heart disease especially in fundamentally low-risk patients. That is, the higher the cholesterol the lower the risk of heart disease and stroke.
I bet you have never heard this startling statistic reported on your evening TV news or presented in one of your daily Internet feeds and certainly not something likely to have been presented in the pharma-captured medical journals.
I imagine that one hundred years from now, doctors will look back in amazement that we strove to lower cholesterol and then obsessively tracked the number just as we can’t believe leeches were used to suck out the “bad blood” of ill patients until nearly the end of the 19th century.
If eating saturated fat and cholesterol does not cause heart disease, then what does? There is a growing body of evidence that says heart disease is caused by inflammation and metabolic dysfunction due to our lifestyles and nutrition choices, not cholesterol and not because of eating saturated fats.
So if measuring cholesterol is nonsense, what should we be measuring? We should measure inflammation and we should measure for metabolic dysfunction - insulin resistance. Here is a list of many of the tests I order routinely in order to asses inflammation and metabolic dysfunction: Fatty acid profile, fasting insulin, fasting glucose, and HbA1c, hs-CRP, LpPLA2, IL-6, MPO, TG/HDL ratio, oxLDL, and active Vit-D. If your doctor does not understand these tests, it might be time to find a new doctor.
Treat potential or actual inflammation and metabolic dysfunction by eliminating seed and vegetable oils such as canola, soybean, sunflower, grapeseed, and corn oil. We should also eliminate refined sugar and processed foods. Instead, we need to return to eating real food such as grass-fed organic beef including their organs, pasture-raised eggs, raw dairy, raw honey, and fruit.
While we are at it, we need to be sure to get a daily dose of sunshine, drink purified water, sleep 7 to 8 hours, and manage our stress. If we do these things and get some exercise, we will significantly reduce our risk of heart disease as well as diabetes!!
Dr. Jeffrey I. Barke can be followed on Instagram @RxForLiberty