What role cholesterol medication?

10. April 2006 William Davis (0)
A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.
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Drive-by angioplasty

Drive-by angioplasty

26. January 2008 William Davis (7)
Don had an angioplasty 6 months ago. When asked about the symptoms that prompted him to go to the hospital, he explained:

"I remember feeling really tired for about a week before I went. I'd read that fatigue can sometimes be a sign of heart disease. But then I had some trouble breathing. You know, like not being able to get a deep breath."

"My wife and I were planning on going on vacation. So I wanted to be certain something wasn't going on in my heart. That's when my wife insisted that she take me to the hospital.

"I kind of remember going there and arriving in the emergency room, but then I don't remember anything. Next thing I know, I'm waking up in a hospital bed. My wife and kids were there, looking all concerned. They said that I just got two stents and that the doctor just barely saved my life."

Happy story, happy ending? Not quite.

I reviewed the angiograms made during Don's hospital stay. They did, indeed, show some plaque, but not anywhere close to the amount necessary to account for symptoms like fatigue or breathlessness. For symptoms like this to occur without physical exertion, say, at your desk or relaxing at home, a critical >90% blockage would be required.

The worst "blockage" Don had was 50% at most. The leap was made to connect his relatively vague symptoms with these "blockages," leading to the implantation of two stents.

This is not as uncommon as you think. Yes, the practice of cardiology can be a life of acute procedures, urgent situations, and crises. Unfortunately, some people with questionable need for these procedures also get swept up in the wave. Sometimes it's due simply to the doctor's need to do "something," nervous family waiting in the wings. Sometiems it's intellectual laziness: putting in two stents seems to satisfy many patients' needs to have something "fixed," even when symptoms like fatigue could be due to anemia, sleep deprivation, a thyroid disorder, or any other myriad conditions that require a diagnostic effort (otherwise known as thinking). And sometimes it's simply done with financial motives, since angiplasty and related procedures pay well.

I call this "drive-by angioplasty," the impulsive, poorly considered coronary procedure that really should never have happened. How often does this happen? What percentage of heart procedures fall into this category? There are no clear-cut estimates. There are crude attempts by independent agencies that have put the number of unnecessary heart catheterizations up to 20% of the total number performed. The proportion of angioplasty procedures, stents, etc. that are not necessary is a tougher number to pinpoint, given the uncertainties surrounding the indications for these procedures, physician judgment that factors into the decision-making process, and the fact that many decisions are made on a qualitative basis, not precise quantification.

In real life, I would put the proportion of flagrant drive-by procedures at no more than 10%. However, that is 10% of an enormous number. The annual cardiovascular healthcare bill is $400 billion. 10% of that is $40 billion--an unimaginable sum. It also adds up to tens of thousands of people per year needlessly subjected to procedures. Consider that 10,000 heart procedures were performed today alone.

Should we push for legislation to control how and when heart procedures are performed? I don't think so. Despite my criticisms of the status quo in heart care, I still favor the freedom and rapid development of a free-market approach. However, you as a healthcare consumer need to be armed with information. You don't go to the car dealer unarmed with information on prices and comparative performance of the car you want. You should do the same with health. Information is your weapon, your defense against becoming the victim of the next drive-by heart procedure.
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Comments (7) -

  • Anonymous

    1/27/2008 11:49:00 AM |

    You've mentioned before about the medical communities bias toward procedural medicine. If hospitals were to change their position and embrace a preventive bias for heart disease treatment, (early detection, and then addressing with appropriate supplements, drugs, and diet.) any ideas on how much savings for the nation could be had?

  • Dr. Davis

    1/27/2008 2:00:00 PM |

    Our analysis suggests $634 million per 100,000 people would be saved if they were to engage in a simple program of prevention using heart scans.

    Our analysis and rationale can be found at http://trackyourplaque.com/library/fl_hh005bankrupt.asp.

  • Rich

    1/27/2008 10:01:00 PM |

    Dr. Davis: I fully agree that legislation is not the answer to this unfortunate practice. I favor freedom for physicians, and an informed public. Government regulation can and will ruin the practice of health care and incentives for new medical techniques and approaches. For those who think the government can be helpful, take a look at Medicare.

  • Anonymous

    1/27/2008 11:02:00 PM |

    I had a “drive-by” angioplasty done in 1999 and a “drive-by” angiogram done in 2000 by the same cardiologist. He told me that I had 90% blockage on one of my main arteries after he performed the first angioplasty. Few years later, a neurologist told me that I actually suffered from panic attacks, not heart attacks. I always wonder how an experienced cardiologist could mistake a panic attack as a heart attack, not once but twice.

  • Dr. Davis

    1/28/2008 1:43:00 PM |

    "To a man with a hammer, everything looks like a nail."

    It holds true in medicine, unfortunately. Especially when each swing of the hammer pays thousands of dollars.

  • Warren

    1/29/2008 2:32:00 PM |

    I have often thought that one underlying force that drives this phenomenon might be the fear of lawsuits.  Being a lawyer, I hate to bash the legal profession, but I know that once the person is on the cath table and any blockage is found that some interventional cardiologist somewhere might choose to stent, some doctors may feel the need to practice defensive medicine.  Even before they get to the cath table this is probably an influence.  In other words, say this patient died of a heart attack soon after this hospital visit (which as we all know, could happen even if the symptoms were unrelated to his plaque burden).  If the hospital had not done the procedure (especially since they have an entire crew of people sitting around all day long just waiting to do these), it's possible that some other intervention-oriented cardiologist might be found who would testify that the standard of care these days is to do the angiogram, and that had this been done, it's quite possible, even likely, that the blockage could have been opened up and death avoided.  (Even though we know that this is speculative and depends on how close to this visit the heart attack occurs, as far as the likelihood that this might be a life-saving procedure.)  The further out the heart attack occurs, the less compelling the causation argument.  But I gotta believe that there is defensive medicine being practiced in some of these situations.  And the trouble is, it's the very state of the treatment attitude that contributes to this result, i.e., the fact that unexpected heart attacks are as common as they are, and the proliferation and ready availability of cath labs, so that they are viewed as routinely available.

  • Dr. Davis

    1/29/2008 2:59:00 PM |

    Hi, Warren-

    Yes. I agree absolutely.

    In fact, I believe this is exceptionally common. So common that it's become acceptable standard of care.

    Often the appearance of doing something is better than the appeareance of doing nothing, regardless of how ineffective the treatment is.

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Dr. David Grimes reminds us of vitamin D

Dr. David Grimes reminds us of vitamin D

3. November 2009 William Davis (13)
In response to the Heart Scan Blog post, Fish oil makes you happy: Psychological distress and omega-3 index, Dr. David Grimes offered the following argument.

Dr. Grimes is a physician in northwest England at the Blackburn Royal Infirmary, Lancashire. He is author of the wonderfully cheeky 2006 Lancet editorial, Are statins analogues of vitamin D?, questioning whether the benefits of statin drugs simply work by way of increased vitamin D blood levels.


There is a fashionable interest in Omega-3 fatty acids, and these become equated with fish oil.

But fish oil is much more. Plankton synthesise the related squalene (shark oil) which, in turn, is converted into 7-dehydrocholesterol (7-DHC). The sun now comes into play and it converts 7-DHC into vitamin D (a physico-chemical process).

Small fish eat plankton, large fish eat small fish, and we eat large fish. So vitamin D passes through the food chain.

This has been a vital source of vitamin D for the the Inuits and also for the Scots and other dwellers of northwest Europe. (Edinburgh is on the same latitude as Hudson Bay and Alaska, further north than anywhere in China). In these locations there is not adequate sunlight energy to guarantee synthesis of adequate amounts of vitamin D, again by the action of sunlight on 7-DHC in the skin.

When the Scots moved from coastal fishing villages to industrial cities such as Glasgow, they became seriously deficient in vitamin D, and so the emergence of rickets. This was followed by a variety of other diseases resulting from vitamin D deficiency: tuberculosis, dental decay, coronary heart disease, and even multiple sclerosis and depression (the Glasgow syndrome).

And so it was with the Inuits. When their diet changed from fish for breakfast, fish for lunch, fish for dinner, they became deficient of vitamin D and they developed diseases characteristic of industrial cities, where there is indoor work for long hours, indoor activities, and atmospheric pollution.

It is the vitamin D component of fish and fish oils that is important.

I recently saw an elderly lady from Bangladesh living in northwest England. I would have expected her to have a very low blood level of vitamin D, as her exposure to the sun was minimal. However the blood level was 47ng/ml, not 4 as expected. She eats oily fish from Bangladesh every day, showing its value as a source of vitamin D with subsequent good health. I expect her blood levels of omega-3 fatty acids would also be high.

But it is unfashionable vitamin D that is important, not fashionable omega-3.

David Grimes
www.vitamindandcholesterol.com


Excellent point. The health effects of omega-3 and vitamin D are intimately intertwined when examining populations that consume fish.

In this study of Inuits, it is indeed impossible to dissect out how much psychological distress was due to reduced vitamin D, how much due to reduced omega-3s. My bet is that it's both. Thankfully, we also have data examining the use of pure omega-3 fatty acids in capsule (not intact fish) form, including studies like GISSI Prevenzione.

Nonetheless, Dr. Grimes reminds us that both vitamin D and omega-3 fatty acids from fish oil play crucial roles in mental health and other aspects of health, and that it's the combination that may account for the extravagant health effects previously ascribed only to omega-3s.
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Comments (13) -

  • moblogs

    11/3/2009 9:29:35 AM |

    Dr. Grimes is a great man. He took a bit of time out to answer a few of my questions by email.

  • Anonymous

    11/3/2009 2:19:24 PM |

    Thank you for the great site. I have learned much from coming here. I recently purchased some vitamin D3 and krill oil. What would be the proper dose per day?
    Thank you.

  • Anne

    11/3/2009 2:45:52 PM |

    Dear Dr Davis,

    I had no idea that fish contained a lot of vitamin D, I knew they contained some but I didn't think it was a lot - maybe this explains my continuing over high 25(OH)D results  - currently 250 nmol/L (100 ng/dl). I only take 2,000 IU D3 per day but I eat lots of oily fish ! I eat a can of sardines every day and large portions of salmon and seabass several times per week. If this is why my 25(OH)D is so high that would be something important to inform my endocrinologist about.

    Anne

  • Adolfo David

    11/3/2009 10:01:30 PM |

    Ummm, but vitamin D elevates HDL cholesterol and statins do not elevate HDL. This analogy is confusing for me at this point, isnt it?

    It has been great to find this blog, I support time ago Omega3 EPA DHA and Vitamin D3 supplementation and also I am LEF member time ago, in whose magazine I have read great articles by Dr Davis. Congratulations from Europe.

  • Adolfo David

    11/3/2009 10:06:39 PM |

    Thinking about that analogy, well statins could active vitamin D receptors with no increase in vitamin D in blood.

    For example, resveratrol can activate vitamin D receptors at least in cancer cells and obviously resveratrol does not increase HDL nor vitamin D (of Steroid Biochemistry and Molecular Biology, february 2003)

  • Dr. William Davis

    11/3/2009 11:39:17 PM |

    Yes, I think that trying to attribute ALL statins' effects to an increase in vitamin D is a stretch. But I believe there's credible evidence to suggest that at least some of the statin effect is due to D.

    Personally, I'd rather take vitamin D and use little or not statin.

  • Michelle

    11/4/2009 1:15:22 AM |

    Great post! This seems to be another example of what can happen when nutrients are taken/studied on their own, instead of in their original context.  I don't discount the credibility of supplements, but so often it seems whole foods are the best.

  • blogblog

    11/5/2009 12:54:21 PM |

    Had Dr Grimes spent two minutes researching the facts he would have realised his theory is highly implausible. Fish oil contains negligible Vitamin D. You would need to consume a whopping 100g of sardine oil every day to get a mere 332iu of vitamin D. http://www.nutritiondata.com/facts/fats-and-oils/633/2 (based on USDA data). However eating large quantities of fish would supplement vitamin D levels.

    Rural Scots and Inuits would have obtained ample vitamin D (up to 8000iu/day) by spending time outside during Spring-Summer-Autumn. The body stores vitamin D for 3-4 months.

    The effects of fish oil and vitamin D are almost certainly separate although some synergistic effect may be present.

  • blogblog

    11/5/2009 1:31:45 PM |

    One of my university biochemistry lecturers said to me many years ago  'nutritional epidemiology is BS because it doesn't account for genetic differences'.

    Inuits don't need high intakes of vitamin D because most of them have the bb allele of the vitamin D receptor. This mutation is also common in other Asian populations This means they use vitamin D extremely efficiently. People with the bb allele have a significantly lower incidence of rickets, osteoporosis and prostate cancer (and presumably depression and heart disease).

    Nocturnal mammals have extremely low vitamin D needs due to extremely efficient vitamin D metabolism. Fruit bats have no detectable serum vitamin D.

  • Dr. William Davis

    11/5/2009 4:06:38 PM |

    Hi, Blogblog--

    I believe Dr. Grimes is referring only to consumption of fish, not fish oil capsules.

    I wasn't aware of the VDR polymorphism in Inuits. Thanks for that insight.

  • buy jeans

    11/4/2010 5:12:42 PM |

    When the Scots moved from coastal fishing villages to industrial cities such as Glasgow, they became seriously deficient in vitamin D, and so the emergence of rickets. This was followed by a variety of other diseases resulting from vitamin D deficiency: tuberculosis, dental decay, coronary heart disease, and even multiple sclerosis and depression (the Glasgow syndrome).

  • Dr David S Grimes

    8/15/2011 9:46:35 PM |

    If you would like to know a bit more about Vitamin D, you could look at 3 three recent lectures that I gave in London in the Spring of 2011. They are available on You Tube :

    Vitamin D clinical experience
    http://www.youtube.com/watch?v=y_mCewkvoFc

    Vitamin D and cancer
    http://www.youtube.com/watch?v=qoXZHhKjVvU&feature=related

    Vitamin D and pregnancy – inheritance
    http://www.youtube.com/watch?v=TIo9a56nOwI&feature=related

    David Grimes

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