By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
It’s American Heart Month once again, a time when health officials scramble to action with trumpets blaring to remind the public about preventing heart disease…
To be sure, much of the fanfare and accompanying advice is solid. Like cutting smoking, maintaining a healthy weight, eating an anti-inflammatory diet with plenty of fruits and vegetables, controlling high blood pressure, and avoiding diabetes, or managing it if you have it.
Along with the good advice come the usual clichés and myths about the dangers of cholesterol and saturated fat, the cardiac world’s eternal scapegoats. If you have been following me for any length of time you know that I regard cholesterol and saturated fat in a totally different light.
In 2013, The Great Cholesterol Myth book that I wrote with celebrated nutritionist Jonny Bowden, reached bestseller rankings. In it, we explained how the medical and pharmaceutical establishments have been bamboozling the public for decades with highly manipulated and skewed research about cholesterol and saturated fat. We also did a follow-up book called The Great Cholesterol Myth Cookbook full of recipes and meals plans dedicated to heart health.
To be bluntly clear, neither cholesterol nor saturated fat are your enemy. My website is full of information about why current cholesterol-bashing is misguided, to say the least. Cholesterol is a natural substance made by your body to produce hormones, vitamin D, neurotransmitters, healthy cell membranes, and digestive acids called bile. Your liver and brain make most of it, but almost all the cells in your body synthesize cholesterol. Your body needs it; life can’t go on without cholesterol.
And as far as saturated fat is concerned, skewed research years ago turned it into some kind of a carbon, hydrogen and oxygen monster, food to be avoided at all cost. Such research has been widely questioned and refuted. Saturated fat, in moderation, is in fact, quite healthy for cardiac health and the rest of you.
Consequently, whole eggs became shunned by many because of the cholesterol hysteria and coconut oil avoided because it is saturated fat. Both are perfectly healthy and desirable foods.
In 2014, an international group of researchers that found no evidence that saturated fat consumption increases the risk of cardiovascular events like heart attacks. Additionally, researchers who published a 2014 study in the Journal of Nutrition reported no risk associated with saturated fat and additional heart disease problems, even among patients who already have documented coronary artery disease.
Are cholesterol-lowering statin drugs for you?
After the cholesterol myth book came out, we received a great deal of feedback from everyday folks as well as people in the medical and research community. There was much praise and support, and, not surprising, pushback from medical people still committed to a high-carbohydrate, low-fat diet, and who still believe that fat will kill you. They all cited studies to support their claims, just as any lawyer does in court.
This is the nature of research and medical practices. People have their biases and cherry-pick the research to support convictions. Having followed the research for years and experienced my own patients’ reactions, I know what I know. And what works and what doesn’t work – that’s what I am sharing with you.
There was considerable pushback against my qualified opposition to cholesterol-lowering statin drugs. Everybody knows about cholesterol involvement in the development of heart disease. Everybody knows it is found at the scene of arterial inflammation and no doubt takes part in the steps that causes arterial plaque. But it is known as well, and certainly by cardiologists, that cholesterol is not the perpetrator, or the be-all-and-end-all of heart disease as has been pounded into the public consciousness by the pharmaceutical industry and its spokespeople in the medical establishment. It is a small risk factor, nothing more or less. But the orchestrated fear of cholesterol has created a perennial demand for cholesterol lowering drugs and many billions in sales.
There is a place for statins. That place is not for primary prevention, for which it is grossly overprescribed. And it is not for most women, for whom the benefits are questionable. The side effects of statin drugs include depletion of CoQ10, a critical antioxidant produced by the body that plays a central role in cellular energy production. There are many ways to prevent the inflammation leading to heart disease, the real cause. A statin is far down the list of remedies, as far as I am concerned.
The benefits for statins outweigh the risks, I strongly believe, only for men under 75, who are not diabetic (statins can raise blood sugar) and who have diagnosed heart disease. I would likely prescribe a statin for such patients, regardless of whether their level of total cholesterol was 150 or 350, but not for the purpose of lowering cholesterol. Rather I would prescribe the drug for its anti-inflammatory and blood thinning effects, and its ability to deter adhesive interactions of clots, white blood cells, and other cells involved in plaque formation. These are the reasons why statins work.
This Heart Month I urge you to take advantage of the many resources that are provided to spread awareness about the number 1 killer of men and women in our country – heart disease. It’s a real and serious threat, however there are many ways you can take action to prevent it. Remember, prevention is always easier than cure, and it’s never too late to start a prevention plan or to take steps that will help you to foster better health.
- Chowdhury R, et al. Association of Dietary, Circulating, and Supplement Fatty Acids with Coronary Risk. Ann Intern Med. 2014;160(6):398-406-406. doi:10.7326/M13-1788. Published online at http://annals.org/article.aspx?articleid=1846638
- Puaschitz NG, et al. Dietary Intake of Saturated Fat Is Not Associated with Risk of Coronary Events or Mortality in Patients with Established Coronary Artery Disease. J. Nutr. 2015. Published online at http://jn.nutrition.org/content/early/2014/12/10/jn.114.203505.abstract?papetoc
© Stephen Sinatra, MD. All rights reserved.