Dietary Cholesterol Concerns Reversed After 40 Years

[W2R]

Interesting experience at the docs today. He thought my LDL cholesterol was a bit "high" because it came in at 107. Of course it was the limit set on the lab report that marked it as H, and claimed <100 mg/dl as the OK range.

But < 100 is the range for someone already being treated for heart disease or otherwise having high risk factors.

< 130 is an appropriate range for someone like me. And even <160 is an acceptable range for someone with otherwise low risk factors.

I was quite pleased with the results, because it was an improvement over a measurement from 3 years ago, especially the total cholesterol at 183. HDL was 51.

Just one of those annoying niggly things. The lab reports have to put a range, and in this case they select one of the most conservative.

This doc is not a cardiologist. And he said he wasn't inclined to be "aggressive" about treating it because people with thyroid issues tend to have somewhat elevated LDL. And I'm sitting there thinking - I don't think that's particularly high.......

It's a lot higher than mine (78), despite my serious problem with obesity that I am constantly battling with less than stellar success, my frequent consumption of New Orleans food which is deliciously unhealthy, and my age (67). But then I'm taking cholesterol meds, and they are doing what they are supposed to do.

It seems to me that, as bright as we are (especially you, who I regard as one of the brightest members of our forum), it still may be helpful to consult highly trained, experienced experts over medical concerns such as this one. If you are dubious about your doctor's evaluation, maybe a second opinion is in order from a doctor that you feel absolutely certain knows this topic forwards, backwards, and sideways and will tell you what you need to know.

When it comes to heart and circulation health, I don't like to mess around because so many people end up dying due to heart trouble. Sure, a second opinion may not be free, but it might be well worth the cost. While there is no guarantee that a lower LDL will make any difference at all, apparently there is at least some chance it might. Most of us just don't have the background to be making these judgment calls IMO.

 

[audreyh1]

I will review with a primary care doctor. With a total cholesterol under 200 and HDL above 50, I am not concerned at all.

But I have studied the new guidelines and <100 for LDL is an old guideline, appropriate for those with heart disease. It is no longer used for everybody regardless of risk factors.

According to the current guidelines I am at very low risk.

 

[Chuckanut]

There is a huge financial incentive to treating healthy people who might get sick, versus treating people who are already sick. The entire 'statins for otherwise healthy people' thing is suspect, IMHO, until I see proof that it significantly reduces death and/or improves quality of life for people who otherwise have no cardio vascular disease.

Here is some information from the NNT (Numbers Needed to Treat) website for people who do NOT have diagnosed heart disease and are treated with statins for 5 years.

Statins for Heart Disease Prevention (Without Prior Heart Disease) | theNNT

Benefits

• 98% saw no benefit
• 0% were helped by being saved from death
• 0.96% were helped by preventing a heart attack
• 0.65% were helped by preventing a stroke

Harms

• 1% were harmed by developing diabetes**
• 10% were harmed by muscle damage

Concerning diabetes they made an estimate as follows:

The raw numbers of 270 and 216 new onset diabetes cases from 24 months of exposure to a statin and a placebo (respectively) can be extrapolated, assuming that increased diabetes risk is likely to continue linearly with exposure. This yields 675 and 540 cases at 5 years. Combining these numbers with the AFCAPS numbers yields a relative risk of 1.22 for development of diabetes (not 1.18 as reported by Cochrane, and NOT 1.81 as we had erroneously reported in an earlier version of this review, which also led to an erroneously low NNH of 50). This updated relative risk increase of 1.22% translates to an absolute risk of 1.12%, or 1 in 89.

This may, however, be flawed in its assumption of a linear increase. Perhaps the increase in diabetes risk is frontloaded, and does not rise above that found at two years. In this case the risk increase would be 1.18 as suggested by the Cochrane group, and the absolute risk increase in this case would be 0.43%, or 1 in 233. The answer likely lies between 0.4% and 1.5%, and we have chosen what we believe to be a conservative estimate of 1% as a midway point in this credible interval.

 

[audreyh1]

Here is some information from the NNT (Numbers Needed to Treat) website for people who do NOT have diagnosed heart disease and are treated with statins for 5 years.

Statins for Heart Disease Prevention (Without Prior Heart Disease) | theNNT

Benefits

• 98% saw no benefit
• 0% were helped by being saved from death
• 0.96% were helped by preventing a heart attack
• 0.65% were helped by preventing a stroke

Harms

• 1% were harmed by developing diabetes**
• 10% were harmed by muscle damage

That's a really great summary. I think it helps to look at numbers needed to treat in terms of whole numbers of how many healthy people needed to be treated with a preventative treatment for 1 person to benefit, rather than percentages. The paper summarized them this way at the top. When you look at it this way, it doesn't look like benefits outweigh the harms for otherwise healthy people.

For preventative treatment over 5 years in people with no known heart disease:

Benefits in Numbers Needed to Treat (NNT)

• None were helped (life saved)
• 1 in 104 were helped (preventing heart attack)
• 1 in 154 were helped (preventing stroke)

Harms in Numbers Needed to Harm (NNH?)

• 1 in 100 were harmed (develop diabetes*)
• 1 in 10 were harmed (muscle damage)

So basically, you have more people developing diabetes, than avoiding a heart attack (just barely), or stroke (lower chance of stroke than diabetes). And you have 1 in 10 people developing muscle damage!!!!! That's a lot higher than those avoiding heart attack or stroke. The muscle damage side effects of statins can be extremely severe.

Yes, I'm really suspicious about using statins as a primary preventative in otherwise healthy individuals, especially women and elderly people. The numbers needed to treat to benefit one person are enormous. The side effects can be serious. And no mortality benefit.

 

[MildlyEccentric]

I will review with a primary care doctor. With a total cholesterol under 200 and HDL above 50, I am not concerned at all.

I wouldn't get too complacent. I had my total cholesterol checked starting in 1985 and never once had a reading above 200 (HDL was below 50 however). 2 plus years ago I was diagnosed with significant coronary artery disease. If you are want to check your risk, here is a link to an estimator.

 

[Chuckanut]

I wouldn't get too complacent. I had my total cholesterol checked starting in 1985 and never once had a reading above 200 (HDL was below 50 however). 2 plus years ago I was diagnosed with significant coronary artery disease. If you are want to check your risk, here is a link to an estimator.

Just to add to anecdotal evidence that proves nothing (), I have a friend who is 85 and his total cholesterol has been 300+ for decades. He has a number of health problems, but heart disease is not among them.

 

[audreyh1]

I wouldn't get too complacent. I had my total cholesterol checked starting in 1985 and never once had a reading above 200 (HDL was below 50 however). 2 plus years ago I was diagnosed with significant coronary artery disease. If you are want to check your risk, here is a link to an estimator.

Yes, I've actually already been through that. My risk score is 1%.

Half of heart attacks have normal "good" cholesterol levels. I don't see the point of lowering normal cholesterol levels "just in case".

Those risk estimators use Total and HDL cholesterol as inputs - not LDL, for whatever it's worth.

If there are other indicators that I have heart disease, the picture changes entirely. But it's not those cholesterol numbers on my report.

 

[d0ug]

The American Eskimo has the least amount of heart problems of anyone in the world there cholesterol is 350 to 500. Natural path doctor say that 220 to 270 is perfectly healthy

 

[RonBoyd]

The American Eskimo has the least amount of heart problems of anyone in the world there cholesterol is 350 to 500. Natural path doctor say that 220 to 270 is perfectly healthy

Again, unsupported blathering. And what, pray tell, is a "Natural path doctor"? (And would he/she have a name?)

 

[d0ug]

Yes the doctor has a name it is doctor Joel Wallach who just received a humanitarian award by the United nations August 5-7 2015. He is far from your average doctor he knows more about health than any 50 doctors

 

[REWahoo]

He's a veterinarian.

 

[tmm99]

The American Eskimo has the least amount of heart problems of anyone in the world there cholesterol is 350 to 500. Natural path doctor say that 220 to 270 is perfectly healthy

Don't they have the highest stroke rate and their average life expectancy is very low?


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[HFWR]

He's a veterinarian.

Ppppppbbbbbb......

 

[d0ug]

He's a veterinarian.

Also

 

[razztazz]

Don't they have the highest stroke rate and their average life expectancy is very low?


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I guess that proves the need to lower cholesterol in everybody. Eskimos die. Would be nice to know some "why" behind those stats. I know they eat almost nothing in the way of fruits and vegetables. That's meant to be rhetorical.

Might have something to do with a balanced diet and micro-nutrients rather than (Tarzan voice) Meat-bad. Cholesterol-bad. Also, like most proud, noble, native peoples they don't like changing what they are ergo they generally can make no progress. They also practice almost no oral hygiene. That is a bigger contributor for cardiovascular disease than cholesterol levels.

 

[braumeister]

The American Eskimo has the least amount of heart problems of anyone in the world there cholesterol is 350 to 500. Natural path doctor say that 220 to 270 is perfectly healthy

Don't they have the highest stroke rate and their average life expectancy is very low?

This is a very complicated issue.

No one, not even residents of the northernmost villages on Earth, eats an entirely traditional northern diet anymore. Even the groups we came to know as Eskimo—which include the Inupiat and the Yupiks of Alaska, the Canadian Inuit and Inuvialuit, Inuit Greenlanders, and the Siberian Yupiks—have probably seen more changes in their diet in a lifetime than their ancestors did over thousands of years.

The Inuit Paradox | DiscoverMagazine.com

 

[ERD50]

Yes the doctor has a name it is doctor Joel Wallach who just received a humanitarian award by the United nations August 5-7 2015. He is far from your average doctor he knows more about health than any 50 doctors

He's a veterinarian.

Also

Also.... what? He's not an MD is he?

WADR, d0ug, you have already posted comments that completely misrepresented the information in the links you provided (only after being asked for references). See my post #68. So, if you really want to influence people, you've got to provide full information, not these little misrepresentative snippets.

-ERD50

 

[fosterscik]

I am interested in the topic of this thread - my wife is a statin user and I like to consider myself well educated. So, given the latest posts, I googled Wallach.
This article was particularly damming: Joel D. Wallach, the mineral doctor - dead doctors don't lie but this live one does - The Skeptic's Dictionary - Skepdic.com
Selected quotes follow:

In the early 1980's, Wallach called himself a "Manner Metabolic Physician'' and treated cancer patients with laetrile, a substance that should not be used to treat cancer. In 1990 he also worked with Kurt Donsbach at the notorious Tijuana clinic Hospital Santa Monica. In 1995, Wallach was using chelation therapy for heart disease, a common misuse of this therapy by quacks.

Wallach seems to be most famous for a widely circulated audiotape he calls "Dead Doctors Don't Lie." [It is also available in video tape and book form.] The label on the tape notes that Wallach was a Nobel Prize nominee. This is true, but meaningless. He was nominated for a Nobel Prize in medicine by the Association of Eclectic Physicians "for his notable and untiring work with deficiencies of the trace mineral selenium and its relationship to the congenital genesis of Cystic Fibrosis." The Association of Eclectic Physicians is a group of naturopaths founded in 1982 by Edward Alstat and Michael Ancharski. In his book Let's Play Doctor (co-authored with Ma Lan, M.D., M.S.) Wallach states that cystic fibrosis is preventable, is 100% curable in the early stages, can be managed very well in chronic cases, leading to a normal life expectancy (75 years). If these claims were true, he might have won the Prize. He didn't win, but he gave a lot of false hope to parents of children with cystic fibrosis.

The label on the "Dead Doctors Don't Lie" tape says "Learn why the average life span of an MD is only 58 years." On his tape, Dr. Wallach claims that "the average life span of an American is 75 years, but the average life span of an American doctor is only 58 years!" Maybe dead doctors don't lie, but this living one certainly does. According to Kevin Kenward of the American Medical Association: "Based on over 210,000 records of deceased physicians, our data indicate the average life-span of a physician is 70.8 years." One wonders where Dr. Wallach got his data. The only mention in his tape of data on physician deaths is in his description of a rather gruesome hobby of his: he collects obituaries of local physicians as he takes his mineral show from town to town.

Wallach is not a physician, but an N.D., a doctor of naturopathy. It is unlikely that most of the people in his audiences know that naturopaths aren't really physicians and that there is a big difference between an M.D. and an N.D. He also claims he did hundreds of autopsies on humans while working as a veterinarian in St. Louis. How does a veterinarian get to do human autopsies?

"Well, again, to make a long story short, over a period of some twelve years I did 17,500 autopsies on over 454 species of animals and 3,000 human beings who lived in close proximity to the zoos, and the thing I found out was this: every animal and every human being who dies of natural causes dies of a nutritional deficiency."

If he really did do all those autopsies and then concluded that every animal or human who dies of natural causes dies because of a nutritional deficiency, then he qualifies for the Ignoble or Ignoramus Prize. To accomplish his autopsy feat, he would have to have done six autopsies a day, working 5 days a week for 12 years, taking only a 2-week vacation each year. He was allegedly performing all these autopsies in addition to his other duties and presumably while he was writing essays and books as well.

 

[MRG]

I am interested in the topic of this thread - my wife is a statin user and I like to consider myself well educated. So, given the latest posts, I googled Wallach.
This article was particularly damming: Joel D. Wallach, the mineral doctor - dead doctors don't lie but this live one does - The Skeptic's Dictionary - Skepdic.com
Selected quotes follow:

Thanks for sharing your information. Saved me from reading what a clown Wallach was. While I'd like to get off of statins I'll let my M.D. make the call.

 

[d0ug]

If you think MD are the God of health they are doing a very poor job as the number of doctors increase the amount of sickness increase now the US has more diabetes, obesity, Alzheimer, and heart problem than most of the world and has more doctors.
How come veterinarians have cured most of these diseases in animals?

 

[ERD50]

bold mine...

If you think MD are the God of health they are doing a very poor job as the number of doctors increase the amount of sickness increase now the US has more diabetes, obesity, Alzheimer, and heart problem than most of the world and has more doctors.
How come veterinarians have cured most of these diseases in animals?

Predictable re-direct.

I'm not defending Doctors right now (that's a separate issue). I'm asking you to defend the statements you made. Again, see post #68.

And how did this N.D. perform so many autopsies? See post #93.

You need some credibility to make these statements, and it seems to be lacking (unless you can fill in the missing details).

How would we know if an animal had Alzheimer's? And how would we know if a veterinarian 'cured' it?

-ERD50

 

[RonBoyd]

Of course there is this from a more believable Veterinarian, "Peter":

Cholesterol reflectivity at 400nm

I think we have to [-]think have to [/-]respect the views of the president of the ACC. ACC is the American College of Cardiologists. These folks are wildly intelligent, free thinking, adventurous, swashbuckling promoters of new ideas. The newest idea on view from the president of the ACC is this one:

‘Some prominent cardiologists have questioned the 2013 guidelines, but the ACC and AHA have shown little appetite to return to LDL targets. “LDL may or may not correlate to cardiovascular outcomes,” Dr. Kim Allan Williams, president of the ACC, told Reuters last week.’

He links to an article by Dr. Malcolm Kendrick, Four legs better.

The American College of Cardiology (ACC) is at the very epicentre of conventional thinking about heart disease. Now the president…. Kim Williams, el Presidenté himself, has made this statement. “LDL may or may not correlate to cardiovascular outcomes,”

You may think, oh well, little slip of the tongue, nothing to see here, move along. Oh no, absolutely not. Whilst I would be amongst the first to criticise and castigate the ‘experts’ in charge of cardiovascular disease research. There is one thing I would never accuse them of, and that is of being careless.

There is no way on earth that this comment would have been made by mistake. It would have been thought about very carefully indeed. Equally, if Kim Allan Williams had thought he was being quoted in error, he would have asked the journalist to obliterate that statement. Before any interview he would almost certainly demand editorial control over copy. I know I always do.

In one way this changed nothing at all, in another way it changed everything. What we had here was an admission, though no-one will admit it, that statins reduce the risk of cardiovascular disease through mechanisms other than LDL lowering. This was shortly followed by the AHA admitting that cholesterol in the diet has nothing to do with raising cholesterol and/or causing heart disease.

More recently several papers have come out clearly demonstrating that saturated fat in the diet has nothing to do with cardiovascular disease.

 

[donheff]

d0ug: to a degree I am on your side of the statin issue in this discussion. I dropped statins 3 years ago. My wife had serious muscular side effects and dropped them as well (and I agree, if you have side effects it doesn't matter whether the risk is low - for you it is 100%). And I am not confident that the medical community really knows much about whether statins are worthwhile or not. The data are all over the place, very confusing, and largely observational, not double blind, controlled studies (the more useful kind). Nevertheless, just because you (or I) am disappointed in the accuracy of mainstream medicine on a given topic does not make us wiser to accept even lesser sources like this guy Wallach or some random blog post. If we are going to wander off on our own course (and I have on statins and diet) it helps to read a lot of pros and cons on the topics we are skeptical of and make an informed decision. Even then keeping an open mind about whether we got it wrong is important. Who knows, maybe some data will come along that convinces me that statins actually offer a benefit sufficient to merit taking them up again. Same thing with sugar.

 

[d0ug]

Here are some doctors who are not drug company shills who agree with me.

 

[REWahoo]

d0ug, why are you worried about cholesterol when you've already identified the silver bullet to insure you make that goal of yours of "living beyond 120 years in good health."

http://www.early-retirement.org/forums/f38/silver-bullet-61789.html

Heck, you've even show us it cures Ebola!

http://www.early-retirement.org/forums/f38/ebola-in-texas-73840-20.html#post1507513