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 wonder if people such as the Kitavans (and other pacific islanders), Hadza in Africa and many other traditional civilizations who survive on sources of carbohydrates like tubers, yams etc walk around with blood sugar  monitoring devices?

Another great and helpful post on blood sugar!
As an overweight, out of shape diabetic, I'm working on this--my blog, http://transformation-transformative.blogspot.com/, is my way of keeping myself honest and tracking my progress.
My thanks for your work!

Always great information!  So you are saying that for the normal healthy person, a target of 40-50 carbs a day is the max we should take in to avoid inflammation and they host of issues that go along with it?  I ask b/c if you eat enough veggies and fruit, even without sugar or wheat, it is easy to push over the 40-50 carbs.  Just wanted to make sure I understand so I can tune in my numbers.  Thank you for all of your work!

Hyper-glycemia is able to increase the levels of matrix metallo-proteinase 9 (MMP 9), an endo-peptidase enzyme implicated in alterations of blood vessels'   walls.  It is thought to play a role in aortic aneurisms; and, since MMP 9 is made in plaque, it is also implicated in ruptures of plaque. There is a notable increase in MMP levels in individuals with  familial hyper-cholesterol and diabetics.

Diabetics have elevated urine & blood levels of MMP 9;  but also above normal levels of  it's  inhibitor  (tissue inhibitor metallo-proteinase, or TIMP). The theory is that these conflicting markers indicate there is an ongoing paradigm, in which  vascular exterior cell matrix (ECM) remodeling is aggravated, by the influence of hyper-glycemia, and this is being opposed by a body response, which tries to keep vascular walls from getting so misshapen they lose function. (To be clear this is not necessarily a narrowing of the inside of the small blood vessels; more a case where, when measured across, it is wider. And then too this is not directly causing any worsening of systolic pressure.)

Since nothing is simple know that both too much MMP and too much of it's inhibitor TIMP are not desirable. On one hand if there is too much TIMP (ie: low MMP) then the ECM can become more fibrous from excess collagen allowed into that vessels matrix; so normal amounts of MMP is desireable. While in another context it is suggested that the way advanced glycation end products (AGE) increases oxidative stress contributes to more MMP 9; and then the high levels of vascular adhesion molecules (VAM 1),  that are notably induced by AGEs,  get to cause more monocyte adhesion to the MMP enzyme prepped vascular endothelium.

I wonder how folks who follow insane diets like Dr. Furhman's Eat to Live manage to keep their blood sugars down? According to his web site, they do manage to doso, and they keep their HDL up and their triglycerides down. There's something going on there but I'm not sure quite what it is. The diet avoids meat and fat, but it also avoids sugar and grains as well. They apparently eat a lot of beans.
Anyway, anyone could get the same results or better without avoiding meat like it's the devil, but that's another story.

The lactose content of yogurt varies a lot depending on how long it's allowed to ferment. Most people don't like sour yogurt, so most commercial yogurt producers stop the fermentation when it's still pretty sweet, even without added sweetener. The sourer the yogurt, the less milk sugar remaining. So differences in BGs after eating yogurt might stem from the level of fermentation as well as from individual differences in blood sugar control and allergies.

Not everyone goes up to 140 after meals, even very carby ones. If you look at this chart carefully, you can see that although many people go over 160 after a carby breakfast, some start below 70 and only go up to about 90 after breakfast.

http://www.diabetes-symposium.org/index.php?menu=view&source=topics&sourceid=16&chart=17&id=322

Some people on diabetes lists have tested spouses, and many say they never go above 90, although with hearsay reports like this it's not always clear when they were testing. Nondiabetics can go up to 160 after a carby meal and be back to below 100 in an hour or two.

One person who had tested diabetic and then lost about 100 pounds said that after the weight loss, he never went over 100 unless he really stuffed himself, and then I think he only went up to slightly over 100.

@ mito: my husband had a major hemorrhagic stroke 10 years ago - he was not a diabetic and his cholesterol was routinely around 150 - he was a SAD eater.

@ mcfreddy: same with the 'starch based' McDougall diet. (high carb, no added fat, no animal or dairy,  just heavy on veggies, fruits, beans, lots of sweet potatoes and potatoes - and grains as tolerated). After the initial adjustment period the majority of followers have normal stats all around.
This whole carb thing just isn't black and white - unfortunately.

Hi rhc,
Would you mind telling how old  your husband was when he had his hemorrhagic stroke ?

A fasted homeostatic blood sugar level equals around1 teaspoon of sugar out of the 1000 teaspoons of blood in your body.  When analyzing food labels & tracking your carb intake the formula to remember is the 1-5-20 rule, meaning 1 teaspoon of sugar equals 5 grams which equals 20 calories.  For optimum health an honest dietitian, nutritionist or doctor will advise keeping TOTAL carb (sugar) intake to around 10 to 12 teaspoons a day MAX, others will say 10 to 12 or 15  total ADDED sugars per day.  12 teaspoons X 5 grams per equals only 60 grams & times 20 calories per teaspoon equals just 240 calories. So yes it's not much, but considering the damage done to the body by glucose from carbs, & since ALL carbs reduce to glucose, less is better.

He was 60 - doing ok but with major right side empairment remaining and only takes one medication for blood pressure.

Hi rhc,
You realize I discussed above an  aortic aneurism; this is not in the brain. As for hemorrhagic stroke there is a risk  condition one can be born with,  relatively rare to be sure, called arterio-venous malfunction; while the common sub-arachnoid hemorrhage can be either looming likewise since birth or as a rupture associated with advancing age.
Sounds like you might be alluding to an intra-cerebral hemorrhage of some artery inside the brain. These are usually ascribed to hyper-tension's affect on brain artery.

For George Zachary ... this was blocked by Server several times when tried to send you over on Doc's 2nd post  back (ie: "The Exception to Low Carb); if anyone wants to copy and paste it there for him that would be nice.  
  
PCSK9 "non sense"mutations that lower circulating LDL cholesterol:
2% of African Americans get 40% less LDL from  these 2 in 80% of those having these:
(a) PCSK9 variant 426C G encoding Y142X (ie: tyrosine at position 142 replaced by stop codon)
(b) PCSK9 variant 2037CA encoding C679X (ie: cysteine at position 679 replaced by stop codon)

3% of Caucasian Americans get 15 to 21% less LDL from:
(a) PCSK9 sequence variant 137GT encoding R46L (ie: arginine at position 46 replaced with leucine)

PCSK9 alleles that both can give 28% less LDL:
(a) PCSK9 9142X allele in 0.8% of African Americans
(b) PCSK9 9679X allele in 1.8% of African Americans

PCSK9 9646L allele gives 15% less LDL in:
(a) 3 % of Caucasian Americans
(b) 0.7% of African Americans

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One crucial difference exists between the modern American and other populations: We have been incredibly overexposed to processed carbohydrates since birth, from teething crackers, to Lucky Charms and Scooter Pies, to pizza and beer, to "healthy whole grains."

We now arrive at later adulthood with beaten up, tired, beta cell-exhausted pancreases that make us unable to deal with the continuing flow of modern processed carbohydrates.

I am assuming you are directing your comments at sedentary unfit people.  Anyone who works  physically or trains as I do (I run and do heavy weight training), could not survive and train on those sorts of amounts of carbs.  If I go below about 200g/day for any length of time my ability to train drops off markedly.

Hi, Aileen--

Yes, indeed. This advice is definitely not intended for people who engage in high levels of endurance training. My wife, for instance, in training for an Iron Man competition, needs to supplement carbohydrates during her training sessions, such as a 112-mile bike trip.

Dr. Davis, thank you really so much. Very interesting article. I believe it is also not just a a matter of the right source of carbohydrate and carb counting but also the right food combining. But what is a person has to do a lot of intelletual work? For example,  when I have to solve a lot or complicated mathematical tasks and make serious projects involving higher mathematics I just cannot do without much carbs, much more than most of my familiy members. Otherwise, it feels like the brain gets dry. On the other hand, physical  workouts never make me really hungry. IS that ok?

I do agree sandra but please explain  I have to solve a lot or complicated mathematical tasks and make serious projects involving higher mathematics I just cannot do without much carbs

Hi, Sandra--

Only people who rely on carbs need them for cerebral work.

I wonder if something to boost acetylcholine might work better? There are a number of neat supplements you can use to achieve this, such as acetyl-L-carnitine.

I suggest Piracetam.

I think it is important to keep the good cholesterol foods intact in your diet.  Fruit has been getting a bad rap lately for sugar, but it is a totally different type of sugar for the body.   Apples were one of my staples when I dropped my cholesterol by 15% and weight by 45 lbs. after receiving a high cholesterol reading.    I also picked out many other good foods that contained healthy or good carbs.  Check out these other important plaque and cholesterol fighters.

www.cholesterolgoodfoods.net