Dear Dr. Davis,
I have read your blog for some time now, and I consider it to be the no 1 in the nutrition-health-cardiology field. A couple of years ago I became interested in the “cholesterol theory” and I have studied the development of the statins in detail. Having a background in the “hard sciences” I am appalled at the lack of sound science in this field in particular, as well as in some other areas of medical research.

To my knowledge there is zero evidence that the lowering of any of the cholesterol levels has anything to do with preventing heart disease or reversing plack. On the contrary, an anti-inflammatory mechanism is probably the reason for the little protective effect there is, while the lowering of the cholesterol levels probably causes more harm then good (as can be suspected from the extensive list of side effects).

Reading this post and the statement, “LDL cholesterol reduction achieved with statin agents does correspond to increasing degrees of plaque reversal”, I couldn’t help feeling that some readers would get it all wrong, especially since “cholesterol lowering” is the healing mantra that is being communicated to the market (and even most doctors seem to advocate).

"Having a background in the hard sciences"? In the "hard siences" they call plaque "plak" ? That was a dead give away that you have no idea what your talking about even before you made the ridiculus statement"to my knowledge there is zero eveidence that the lowering of any of the cholesterol has anything to do with preveting heart disease or lowering plak(sic)" You should read some of the studies, they're easily found on the internet or in journals. By the way did you look at the pictures Dr. davis put up in the article? As Dr. davis always says I don't work for the drug companies and statins certainly aren't miracle drugs but they do have a place. Ever hear of the Framingham Study, just a small study thats been going on for over 60 years now and has studied over 10,000 people( now in its third generation) and they have NEVER had a recorded heart attack in ANYBODY with a cholesterol level under 150. So much for "your knowledge"

Dear Dr. Davis,

In reading this and about vitamin D, if you have a plaque problem, but your HDL is high and your Vitamin D level in normal, would it still be helpful to take the suppliment?

Dear Anonymous, there is no need to be so sarcastic, and I apologize for spelling plaque plack. Do you mean to say that all of medical science is of high quality, and that it shouldn’t be questioned? Most of the serious critique against the cholesterol hypothesis comes from medical researchers by the way. I am waiting to be enlightened, please show me the evidence that the LOWERING of cholesterol by it self (per se) is the protective mechanism of statins.

From your writing it appears that you still believe in the old dogma of high cholesterol CAUSING atherosclerosis. Only a few of the fiercest statinators in the research community still maintain that, and probably so for financial reasons (most statin-advertising is doing its best to communicate just that). Most GPs seem to believe that cholesterol causes atherosclerosis too. It is trivial that in any academic context “correspond to”, “linear relationship” or “associated with” do not mean “direct effect of” or “directly caused by”. With this simple understanding we would have better doctors and better scientist in the medical field, and consequently less treatment of SYMPTOMS such as high cholesterol, high blood pressure and high blood sugar. By the way, is there any proof that atherosclerosis is not causing the higher cholesterol levels instead of the other way around?

The problem with many defenders of the cholesterol dogma is that they don’t read the scientific literature in a scientific way. I personally don’t know of anyone still believing in the cholesterol hypothesis after having studied it in depth from strictly scientific principles. There is simply no evidence to motivate all the “lowering” of “levels”. It is nothing more than a highly profitable market concept ($30 billion in 2007).

Great write up.

As  a diabetic, with all of my numbers under very good control, I have been on statins for 8 years and my last two heart scans (5 years apart) had a score of 0 plague.  My question is the following:

Are you saying that statins are good and should be part of a comprehensive approach?

Many websites that push your blog are against the use of statins in any approach.  How do you respond to that type of thinking?

Should you continue taking drugs to reduce your plague if your score is zero?


Thanks for your time

Playing devil's advocate, I'm not sure if science has proved cholesterol to be a cause of heart disease. What if it's a marker and not a cause?

Those in the Framingham study with low cholesterol values might not get heart attacks due to lifestyle/genetics, and their low cholesterol is a reflection of their overall good health?

Those who take high dose statins obtain benefit from less inflammation, but not because of cholesterol reduction?

I'm not saying the above two statements are true, but it could be possible. It could also explain why statins, as a single treatment, usually don't work for most people, and why the Vytorin/Zetia/Torcetrapib trials failed so miserably.

Or it could be that the reduction in LDL wasn't enough to matter, or that particle sizes for LDL/HDL wasn't taken into account, or some other factor? It appears that  right now, there isn't hard data that proves what causes heart disease exactly, but simply a lot of risk factors and disease markers instead.

I never suggested that Cholesterol by itself caused heart disease. Clearly many things do, inflamation, CRP, Lp(a)... On the other hand to suppose that cholesterol has NOTHING to do with heart disease is foolish. Show me a cardiologist that believes cholesterol has nothing to do with heart disease and I'll show you a quack. It may not even be the main cause of heart disease in most people but the fact of the matter is reducing LDL lowers the the chance for heart attack in a good number of people. Have you ever heard of Dr. Agagston ? He of the South Beach Diet fame, a cardiologist in South Florida, who by the way the way of scoring calcium scans is named after. See what he thinks of statins and reducing cholesterol levels. and as Im sure you know it gets much more complicated than that when you get into particle size. Take a person who's scans keep going up because he has small LDL and nothing in Dr. Davis program has worked for him 9I am such a patient of the good Dr.s) The best you can do for such a person is lower his LDL as far as you can since its all going to be small particle anyway. I would also refer you to Dr. Greg Browns HATS Study for examples of lowering cholesterol and lowering heart disease or Dr. Davis' example that started this discussion. I apologise if I came off a bit sarcastic in my earlier comments I think this is an important issue to get all points of view on.

Great thead.

So what are you really saying about statins?  Is there value taking statins in combination with other treatments for men and women?

How do you address the comments that states statins don't work?

Thanks for your time.  Your comments are really appreciated.

There is NO DOUBT that statins reduce the chances of a person having a heart attack, NONE. There is question as to what about the statins does that, is it lowering LDL, is it stablising plaque, is it reducing inflamation . . .? Or is it all of these ? And there is no doubt statins have side effects, some serious, but the fact that they reduce heart attacks, that argument has been settled.

I will not go deeper into the science of atherosclerosis except to say that it has been known for several years now that cholesterol per se does not initiate atheroma, or plaque. You find cholesterol in the lesions but you also find calcium. We find cholesterol and calcium because it is available in the bloodstream. Cholesterol does not have a mind of its own, and it doesn’t one day decide to develop plaque by raising “the level”. Neither does calcium.

We need cholesterol for many important processes in the body, and it is a part of almost all of our cell membranes. Mother’s milk is packed with it because the baby needs it. Eggs are full of the stuff “because it takes a hell of a lot of cholesterol to make a chicken”. The body has the level it needs at all times, and a higher level could indicate that something is wrong, i e, it is a marker, like someone said. Lowering of levels makes no sense at all.

It is just dumb luck that the cholesterol lowering statins happen to be anti-inflammatory and therefore have some preventive effect, and may reverse plaque in some cases. The higher the dose the more anti-inflammatory effect, and reversal of atheroma. The higher the dose the bigger the lowering of the cholesterol level, because that is exactly how statins are designed to work. However, there is NO evidence in the scientific literature that the lowering of the cholesterol level has a protective effect, and I am very sorry if this upsets anyone’s religious beliefs. Dumb luck, as I said, the rest is coincidence and correspondence. Big Pharma will do its best to uphold the “religion” though, since it is so profitable. Levels will always be too high, and everybody should be statinated. Statins should be distributed in the drinking water, no less.

So, why bother, the statins seems to work in a few cases? Well, statins are really poisonous substances, and there are many indications that they cause harm to the human body, particularly by the lowering of cholesterol levels. Side effects are plentiful and it is probable that we will witness statin induced cancers in large numbers in the near future.

The point to be made here is that there are other and better methods to avoid atherosclerosis and to reverse plaque. Dr Davis is one of the leading proponents of such methods. I personally think it is interesting to se the results of the statin study presented here; I just wanted to stress the point of what statins really do. By all means, we should keep an eye our cholesterol levels. But many people having a hearth attack do not have high cholesterol. But did you know that 90% of them have diabetes or in some other way a pathological sugar metabolism? So what level is the more important?

About the quacks, who don’t buy the cholesterol dogma, there are thousands of them. Some of them can be found at www.thincs.org. If you are interested in how the cholesterol religion was developed and how science was corrupted to that end, I can recommend Gary Taubes latest book Good Calories – Bad Calories.

By the way, CRP is just another marker for hearth disease, but I wouldn’t be surprised if there will soon be talk about lowering the level

Well by your klogic there is no scientific proof the lowering inflamation is what cause stsatins to lower your risk of a herat attack, the only thing we do know is that ststins DO infact lower your risk, we just all keep guessing as to why. Well heres another piece to the puzzle: double blind study releasesed this week follow groups of people on statins or placebos and by a slight BUT significant margin the statin takers blood oressure was lowered ! So besides all the other things we think statins do we now KNOW they lower blood pressure. 2 ver5y interesting points for all of our paranoid readers 1. Not one of the study members recieving the statins in the 2 year period had to leave bececause of side effects and 2. this study was NOT paid for by the big bad scarry Drug companies, so there goes your default response.

I am no supporter of drug companies, nor a defender of their policies and practices. But I do believe that their data can serve to teach us a few lessons. For instance, here is an (cherry-picked, to be sure) example of intracoronary ultrasound cross-sectional images before and after two years of rosuvastatin, 40 mg daily:

I know enough to not stress about lipid levels that send some docs for their prescription pads.  However, I was a bit shocked to see my recent numbers as follows:
TC 465
HDL 102.18
Trig 48.95
LDL 353.73
Even doing a more accurate calculation, the LDl is high, although all the ratios seem to be in order.  I'm mid 50's, slim and with no family history of heart disease.  I also do not have any of the indicators for Lp (a).  Anything else that would cause this?

Dr. Davis,

I was wondering why my HDL went up with my latest Lipid Panel test results I received yesterday from my Endocrinologist (Type 2 diabetes). It was a pleasant present on my 60th birthday – HDL of 65!

My Lipid Panel results: - Total Cholesterol -127,     HDL – 65,  Triglycerides – 51,  LDL - 52

I have been taking 4,000 IU of D3 for the past six months after reading your blog. Actually, my HDL was in the mid fifties to sixty since for a few years I have been taking 500 mg of Slo-Niacin along with two Omega 3 fish oil capsules per day. Added to this is four days per week at the gym for the last three years. This helps too.

My HDL has never been so high at 65 and I didn’t realize the positive affect of the Vitamin D3 until the current test results.

I believe my LDL is so low because I am taking a 20 mg dosage of Simvastatin, although I am now taking it every other day. Along with the Simvastatin, I am taking Metformin and Diovan all prescribed by my Endocrinologist. After researching on the Internet I added the Omega 3, Niacin, and from your blog Vitamin D3. My doctor doesn’t have much to say about this, although I have mentioned it to him.

Vitamin D3 really seems to work on the HDL!

Now I really have to try to cut down on my wheat consumption to drop my A1c below 6.4.

I appreciate your blog along with your book.

Thanks for all your helpful information.

David

Anon--

You must--MUST--consider getting an NMR lipoprotein test to obtain the LDL particle number.

Given the very high HDL , it is possible that the true LDL is far, far lower than the calculated LDL. It likely will be high, but not that high.

Great work, David!

Dr. Davis:  How do you know the increased HDL is due to the D3 and not from the wheat elimination you recommend?

Raises TC?!!!  Wow, thanks!  Gonna print out and show to Primary, Endo, and Cardio who are talking statins (Primary said statins or niacin). Comments?

Aug 08: D=15.2, TC=212, TRI=181, HDL=47, LDL=129, TSH=2.795(normal free T3 & T4), A1C=11...50K IU/wk of D2 for 8 wks, then 1K D3 daily. Very low carb diet, metformin ER, Januvia (terrible CNS side effects), Maxzide, Cozaar. BP=140s/65 <1800 mg sodium told to add a bit more.

Dec 08: D=33, TC=205, TRI=119, HDL=57, LDL=124, TSH=4.289 (normal free T3 & T4), A1C=6.9, TSH=2.667(normal free T3 & T4)...2K D3 daily.  Very low carb diet, metformin ER, Maxzide, Cozaar (half dose). BP=130s/75

Jun 09: D=36, TC=231, TRI=119, HDL=57, LDL=150, TSH=4.548(normal free T3 & T4), A1C=6.4...4K D3 daily.  Very low carb diet, metformin ER, Maxzide, Cozaar (1/4 dose) on days following apnea events that wake me up (on CPAP), aver BP=128/72

Sep 09: D=41, TC=235, TRI=145, HDL=60, LDL=147, TSH=5.51 normal free T3 & T4), A1C=6.5 (tried new foods-meals & spiked)...4K D3 daily (thinking of upping to 5-6K).  Very low carb diet, metformin ER, Maxzide, Cozaar (1/4 dose) on days following apnea events that wake me up, aver BP=130/70, started generic Levothyroxine 25 mcg/day, just started Iodoral 12.5 mg a wk ago--body temp finally staying the 98s. Subbing a high-protein (lots of BCAAs) shake for breakfast and 1/2 shake for snack -- lost 4 pounds in 6 days (monitoring BGs frequently). ApoB=111 (<109 normal)...oops.

So, are my rising cholesterol numbers the results of the following or ?
- Very low carb (<40 gms) diet (guessing larger LDL particles)
- Rising TSH levels(hypothyroidism increases cholesterol right?)
- Increased amts of D3

60 yo female. Lost 50+ pounds but still obese (takes time). 35-60 mins/day low intensity recumbent exercise bike. Laidoff--lots of angst & stress.  All other bloodwork results good (high RBC down to normal, guessing less apnea desats). Using topical progesterone, 3 wks on, 1 wk off a la Dr John Lee. No CVD in family, just Type 2 and hypothyroidism.  If niacin is good, which form?  Not sure I can handle flushing, have touchy skin, used to have rosacea.

Anonymous,

Hypothyroidism will jack up cholesterol and LDL.  People can be hypothyroid even if they're slim.  Have you had your FT3 checked?

I actually found different. I've been on 10,000IU of D3 and found a general dip in my cholesterol levels (although a slight increase in HDL).

Here's a scan of my results in '07 (when I was just 15nmol/L) and recently where I'm above 76nmol/L (I just say above as my most recent D reading is yet to arrive).
http://bit.ly/3h9X4C

Of course it may be co-incidence too, but both my brother and father have had no change at all in their cholesterol levels in the last few years. My brother's on D but only just enough as recommended by a doctor.

My levels this year are now well below UK average (which is 5.7mmol/L and I'm now 4.95 from 5.62) and correspondingly I wasn't told to modify my diet or go on a statin, even though my cholesterol level was deemed as only marginally high before.

wow.. how could it be? in fact, if that's gonna be true, not all vitamins are good for the body in the sense that it has a side effect inside the body.

I read this and then immediately ordered some vitamin D.

Anonymous,

Has your LDLs always been this high or have you never had your cholesterol tested before? If so, then perhaps you have Familial Hypercholesterolemia like I do. If your LDLs have been tested before and were never that high, then it must be something else.

Since your Trig. are so low and your TC is over 250, the standard Friedewald equation isn't the most accurate for you. Here is a better calculator for people like you:

http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

Regardless, that still is a high LDL. Have you recently started taking new supplements?

The reason I ask is because I was once was advised to take a several difference supplements in the hopes of raising my Testosterone and they all had some zinc in them and my LDLs skyrocketed (even for me)! I later learned that too much zinc can do this. I was taking around 100 or 110mg of zinc daily if my memory serves me correctly. I believe taking too much zinc can adversely affect copper levels which in turn can raise cholesterol. Now I try to stay around 100% to 200% of the RDA (15mg - 30mg) and I don't have that problem.

Are you taking sterols? Maybe you're absorbing the sterols...just a thought.

Maybe it was a just lab fluke. I would recommend a retest (preferably using a NMR or a VAP test).

Good luck!

John M.

Put your numbers through this

http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

it brings your LDL down to 286, still a bit high, I'd suggest there's something else occurring, could be thyroid?

One "authoritative" site for calculating cardiovascular risk won't even permit HDL levels over 100 to be entered, so you've aced that, and the trigs

http://www.elements4health.com/cholesterol-buildup-in-diabetes-patients-deficient-in-vitamin-d.html

interesting...have you read or posted on this yet?

LDL Calculator gives
LDL = 353.03  (mg/dL) as per Friedewald formula

LDL = 285.63  (mg/dL) as per "Iranian" formula

Dr Stephan on  Friedewald

Previous Dr Davis post on  Friedewald equation
Triglycerides divided by five

Total Cholesterol is by far a wrong way to measure the risk of heart disease. In this case, if the doctor she was going to was one among many she would have been prescribed statin drugs without further investigation. Higher Cholesterol must be bad right - let's make a buck and sell her some lipitor or Simvastatin! People in general are too uneducated and trust doctors more than anything else. This makes me scared! A low carb high fat (LCHF) diet will gett people more healthy all over! Better cholesterol quota, less over weight, less risk of developing type 2 diabetes, less risk of inflammation, and better energy! You can't go wrong! Thanks for this very important post!

Dr. Davis,
Thanks so much for your response.  Would it make a difference to know that I have eaten low carb for several years, and seldom eat grains?  Also, apparently my lipids were 'normal' when last checked 10 years ago.
My GP claims ignorance of the difference between calculated and direct measure of LDL, or of different particle size.  He just knows the numbers the lab sends.  I believe I would need to see a specialist to get tested further.  Worth the trouble?

Hi, Steve--

You are absolutely correct: Given sufficient time, wheat elimination increases HDL also. However, vitamin D can also increase it independently. I've seen many people add vit D to an already established no-wheat diet and still send HDL through the roof.

Lyn--

As you can see, it's probably a combination of all the good things you've done.

I've been supplementing with 6,000 mg of D3 each day for a month and following a low carb but not wheat-free diet for 2 months. I was surprised to see my HDL come back so low and my LDL so high on a recent test:

HDL: 34
LDL: 203
VLDL: 9
Trig: 47

I will add Niacin to my supplement regimen to help bring down the LDL, and eliminate wheat. I am about 40 lbs overweight, with no other health issues (that I know of!). My A1C and fasting insulin numbers are good (A1C 4.7, Ins 4.3). I wonder if I need to pursue a more agressive approach to bring down my LDL, or just give the Vitamin D/Niacin supplementation time to work (and give up wheat)?

Very good information. Many people do not understand how to decipher the information when they get the results of a cholesterol test. This should help out some.

I started taking 500mg niacin daily
(for 40 days now) and increased my HDL to 49 from 35
but my TC went from 189 to 251!
(my trig is 62)
Can niacin increase TC also?

Lieta--

When it comes to vitamin D and wheat elimination, it generally requires about 6 months for full effect to be reflected in your blood work.

So patience pays!

Anon--

Niacin or any other agent that increases HDL will likewise increase total cholesterol. It's all good!

Do you have a recommended brand of Vit D3?  Does it have to be taken with Vit A (as I've read in some other places)?

Thanks

Does the lack of useful information in total cholesterol value extend all the way down to 150 and below, which is the level Joel Fuhrman and others say people should strive for?

This reminds me of a story that the renowned physicist Richard Feynman told about the poor quality of textbooks he had reviewed, which gave students totally useless problems with no practical purpose.

His example was a problem that listed the temperature of 3 random stars, and asked the student to calculate the total temperature, a totally meaningless and pointless number that tells you absolutely nothing about anything.

I have looked at many sites on this subject and not come across a site such as yours which tells everyone everything that they need to know. I have bookmarked your site. Can anyone else suggest any other related topics that I can look for to find out further information?

Dr. Davis,

Do you have any studies to support that vitamin d increases HDL? I've searched it and could find nothing but neutral studies on it or studies in combination with omega's and niacin.

This study that was ONLY with vitamin d saw no effect.

http://www.ncbi.nlm.nih.gov/pubmed/19352377?dopt=Abstract

and this study showed that atorvastatin needed adequate vitamin d levels in order to work.

http://www.hindawi.com/journals/ije/2010/320721.html

but I couldn't find anything saying that vitamin d raised HDL. Any references that you can refer me to or is this just your observations?

Vitamin D doesn't raise cholesterol - cholesterol uses sunlight to synthesize or create Vitamin D.  If you are taking a cholesterol lowering medication, your body can't process the cholesterol to make Vitamin D.

In May 2008 I had a D3 level of 25. Now it's near 80, after 1+ years on 5000 IU of D3 per day. My LDL cholesterol has gone up (it's in the 170s) and my HDL is still low (40-50). HDL has actually changed very little while LDL has increased over time since the first time it was tested in 2002.

Despite the info presented here, I'm not convinced that there's such a clear relationship between LDL and Vitamin D.

So the dominant effect of vitamin D from a cholesterol standpoint is a substantial increase in HDL. Looking at the equation, you can see that an increase in HDL is accompanied by a commensurate increase in total cholesterol. If HDL goes up 25 mg/dl, total cholesterol goes up 25 mg/dl.

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Thanks a lot for the tips. Reduce your cholesterol by taking the necessary vitamins and supplements. Avoid eating fatty food and focus more on eating healthy fats.

-Supplements Canada

Vitamin D3 supplements will absolutely increase both your LDL and HDL cholesterol.  The impact on each can be quite large.  I know people want to believe that supplements can do nothing negative, but it is what it is.  All you have to do is buy a Cardiocheck PA meter or the like and test your cholesterol at home.  Take 5000 IU per day of vitamin D3 for 2 weeks and recheck -- your LDL will go up dramatically, and your HDL will rise as well (and so your total will increase a fair amount).  The exact same thing will happen if you get massive amounts of sun without sunscreen over a number of weeks.  Who know whether this effect is a good or bad thing -- your guess is as good as mine.  But I'm always amazed at all the $30 million dollar studies that have to be done to find out what any person can see with a single affordable at-home monitor...