The History of Cholesterol Lowering Drugs
In the early days of the cholesterol history, Dr. Ancel Keys in Minnesota performed research looking at the links between diet and heart disease. In these early studies, it was evident that people who had lower cholesterol had lower rates of heart disease. That became convenient later. This information stemmed from the research from Nikolai Anichkov in 1913 who found that rabbits fed a high cholesterol diet subsequently developed atherosclerosis (hardening of the arteries). Thus began the development of one of the most massive drug company endeavors of all time.
This information changed decades of dietary recommendations centered on lowering fat and cholesterol intake. Foods like avocados, eggs and shrimp were avoided because they were known to be high in cholesterol. The entire USDA food guide pyramid was centered on the concept that fat and cholesterol were the main contributors to cardiovascular disease.
The Statin Story ($$)
Conveniently, the pharmaceutical company Parke-Davis (later acquired by Warner-Lambert and then Pfizer) had a drug in development that was able to inhibit the enzyme HMG coenzyme A reductase and stop the body’s production of cholesterol.
Mevacor (lovastatin) was the first statin cholesterol lowering drug approved for use by the FDA in 1987. But it wasn’t until 1996 that things changed.
When Lipitor was first patented in 1996 the belief that cholesterol led to heart disease was so well-entrenched that the clinical studies done did not need to prove that Lipitor lowered heart attack rates and saved lives. Pfizer just had to prove that it lowered cholesterol levels.
And they did. Deal done. Lots of high-fives and back-slapping and LOTS of money made. Lipitor was the first drug to pass $20 billion in annual sales.
And so it stayed for years, until the studies were done looking at what you REALLY care about. No one really cares what his or her cholesterol is—they just don’t want to have a heart attack. But when the studies came out looking at just how well the statins protected against heart attacks and death that the researchers were left shuffling their feet and mumbling quietly.
It should’ve been the end of the era of statins as the blockbuster class of drugs for the heart. But it wasn’t. Rather, it stayed, and remains, one of the most commonly prescribed drug classes.
But they couldn’t do that without the help of the medical community. Pfizer was able to do this because the majority of doctors do not read medical literature. Fewer still understand the nuances of the medical research they read.
Because of this, they were too easy to fool with manipulations of the data from the studies. Your doctor really did think he or she was doing the best he or she could for you, but did not understand enough about the game being played.
Absolute risk reduction and relative risk reduction. That’s the game that was played.
No matter what study you look at, no matter what lab value you look at, no matter whether you have had a heart attack or not (primary or secondary prevention), the numbers all fall out pretty much the same.
You have to treat ONE THOUSAND PEOPLE with cholesterol lowering drugs for FIVE YEARS to prevent 11 heart attacks. If you didn’t treat these 1,000 people with statins, 22 people would have heart attacks.
There is no other way to say it—these drugs absolutely SUCK at preventing heart attacks and death. And this doesn’t even take into account the side effects (detailed later).
Let’s look at this from a different angle. Despite the numbers being dismal at lowering the risk of a heart attack or death, it WAS a 50% drop in the number of people having a heart attack when statins were used (22 versus 11).
This number is the relative risk reduction: 50%. This was the number that was promoted to doctors. “Given a statin drug to your patients will lower their risk of a heart attack by 50%.” Sounds good when the drug companies put it that way.
And if your doctor did look up the real data or didn’t understand the real data, he or she really thought he or she was doing the best for his or her patients.
THIS was the wool that was pulled over all of our eyes, at the massive expense of healthcare dollars and atorvastatin side effects.
Atorvastatin Side Effects
When asked, most will note that muscle pain and weakness is the main side effect associated with atorvastatin and the other statins. While this is true, the story is far, far greater than anyone realizes.
The muscle side effects of cholesterol lowering drugs
Muscle aches and pains, muscle weakness, rhabdomyolosis (muscles breaking down, often fatal). These are all well-accepted side effects of cholesterol lowering drugs. Here are some facts:
- All statin users have muscle damage, regardless of whether they have symptoms or not
- Many athletes cannot use statins because the statins block their high performance
- In clinical studies, “muscle side effects” are broken up into as many as 10 different categories. This allows each category to appear small, as opposed to a part of the larger class of muscular side effects. In most studies, the categories of muscular side effects can be as high as 20%.
It is likely that most of these muscular side effects of statins come from the drug’s blocking of the production of coenzyme Q10 (CoQ10). CoQ10 (also known as ubiquinone due to the fact that it is present in every cell of our body) is absolutely essential for the healthy functioning of our cells. The higher the metabolic demands of the cell, the more important CoQ10 is. Interestingly, Mother Nature saw fit to put the production of cholesterol on the same metabolic pathway as CoQ10.
Block HMG coenzyme A with statin drugs and you block CoQ10 production. The degree of the shutdown of CoQ10 production varies with the individual and the strength of the drug. In some, this shutdown is fatal. Period. Yes, some die from taking a drug that was not going to do anything substantial for them in the first place.
Neurological Side Effects of Cholesterol Lowering Drugs
Much like the muscular side effects, in clinical trials the neurological side effects are broken up into a number of different categories. This again allows reporting of side effects as minimal, when, in reality the total number of patients experiencing neurological side effects hovers around 20% as well.
As I mentioned, CoQ10 is important for high-demand tissues. This includes the central nervous system. Shut down CoQ10 production and neurological tissues will suffer.
The most common side effect of statins on the nervous system is on memory and cognition. Studies have demonstrated that statin users have experienced:
- Memory loss
- Cognitive decline
- Polyneuropathy (nerve damage to multiple nerves)
- Increase in absence seizures
Other less-known side effects of statins
While the muscle and neurological side effects are the most notorious (or at least they were until the biggie side effect hit a few years ago—more on this later), there is a long list of other side effects. These include:
- Heart damage (yes—heart damage—most likely from the abovementioned CoQ10 block)
- Fatigue / lack of energy
- Rheumatoid arthritis
- Lower health-related quality of life
- Worsening knee arthritis (ironically, in a study designed to see if statins would help)
And probably quite a few more that I can’t think of right now. Overall, though, you should get the idea that these drugs are, quite frankly, dangerous. For me, the surprising thing is just how broad-reaching the side effects are, cutting across pretty much every organ system.
And all of this for a paltry benefit on lowering the rates of heart attack.
But, believe it or not, it gets worse.
Cholesterol lowering drug side effects—the biggie
In 2010, a very large review of 91,000 patients across multiple clinical trials identified the most disturbing side effects of statins yet. (Unless, of course, you happen to have had your muscles melted and kidneys destroyed—that’s pretty disturbing…)
The biggest concern for diabetics is the risk of heart disease. Upwards of 70% of diabetics die of cardiovascular-related complications. From a lifestyle and functional medicine standpoint, diabetes and heart disease are pretty much just two sides to the same coin.
It has been well-established that certain diabetic drugs increase the risk of cardiovascular complications. The black box warning on Avandia is the shining example of this side effect.
But what if a drug designed to protect the heart increased the risk of diabetes? That’s a pretty bad thing, right?
Well, you guessed it. In this large review of 91,000 the researchers identified a 9% increased risk of diabetes in patients taking statins. This finding has been confirmed in other studies and is now pretty well established.
Although 9% doesn’t sound like a big deal, remember that statins’ overall net protection against heart disease is 1%. The numbers work out that, for every 1,000 patients given cholesterol lowering drugs, 11 will have a benefit against a heart event, but 9 will develop diabetes (and then later go on to develop heart disease).
A net gain of 2 out of 1,000. That pretty much sums up the wonder drug of the century that is the single most financially successful class of drugs ever developed.
But, it gets just a WEE bit worse…
The statin users who developed diabetes? They were the ones at the lowest risk of diabetes in the first place.
So…it is highly likely that, if you have high cholesterol, you are prediabetic. But, just in case you are one of the few that who is NOT at a greater increased risk of diabetes, taking drugs to lower your cholesterol will pretty much fix that.
With all this information available, just how does this drug remain so widely prescribed? I can’t quite figure that one out either.
The Role of Supplements to Lower Cholesterol
Heart disease, diabetes and cholesterol issues are almost entirely lifestyle-related. Because of this, the role of supplements should be limited. I have never and will never recommend products like red Chinese yeast rice (RCYR) to lower cholesterol. Products like these have a single-minded purpose and do nothing to really fix the underlying process leading to the elevated cholesterol.
That being said, there are several supplements that have a good track record for preventing or improving cholesterol that work in indirect ways that actually address the underlying problem. Just keep in mind that these supplements are designed to be used WITH lifestyle changes, not instead of lifestyle changes.
Fish oils / omega-3 fatty acids to lower cholesterol
Dietary intake of healthier fats is one of the most established approaches for lowering your risk of chronic disease, regardless of which one is on your list of concerns. For this reason fish oil / omega-3 supplements are on the list of supplements that play a strong role in managing cholesterol issues.
When it comes to fish oils supplements, there are two very important factors. The first factor is quality. Research on fish oils has demonstrated that lower quality fish oils that contain contaminants actually increase the damage done to the body rather than protect against it. For this reason staying with higher quality fish oils (like Nordic Naturals that can be found on Amazon) is a smart idea, even if they are a little bit more pricey. As an added bonus, higher quality fish oils are less likely to cause repeating (that absolutely appetizing fish-burp taste).
Next factor is dosage. I find that many of my patients who have been told to take fish oils by their doctors are not taking a high enough dosage. In general, the higher your cholesterol, the higher dosage you will need. Most will see a strong benefit at 1500-3000 mg (1.5-3 grams) per day, taken in divided dosages (such as breakfast and dinner).
This is where your small-font reading and math skills need to come into play. If you squint really hard at the supplement facts label, you’ll see that not all of the components of the capsule are omega-3 fatty acids. The strength actually varies quite a bit. Regardless of strength, the omega-3 dosage will be given in milligrams, so you’ll have to do the math to make sure you’re getting as much as you need.
This may mean that you have to take anywhere from 2 higher strength capsules (at 1500 mg) up to 10 lower strength capsules (at 3,000 mg). The same applies with the use of krill oil capsules – there is nothing that supports the idea that krill oil is some miraculously powerful supplement that can be used at 300 mg. I’ve reviewed this topic in a FAQ video you can watch below.
Vitamin D and Lower Cholesterol
There has been no lack of research and news stories on the sunshine vitamin in the past decade or so. Despite its name, vitamin D is not a vitamin, it is a hormone. That means that vitamin D actually changes the way the DNA of your cells function, depending upon the cell type that vitamin D is affecting at the time.
There has been research linking low levels of vitamin D to pretty much every chronic disease known to man. For the clinical studies that use vitamin D supplementation to lower the risk of chronic diseases, the research is not as strong. There are a few things that vitamin D supplementation has been shown to be good for and lowering cholesterol just happens to be one of them.
The cholesterol-lowering effect is not that strong, but given that vitamin D deficiency is at near-epidemic proportions, supplementation is incredibly cheap (some $20 / year) and has an effect on any number of other chronic diseases, it makes a lot of sense to add this to the list of your supplements.
How much vitamin D to take can be a very personal thing based on your individual health, but 2,000 IU / day is a very safe place to start. For patients who avoid sunlight, who have had his or her gallbladder removed, have autoimmune conditions, are diabetic or have bone health issues I have started them on 10,000 IU / day.
Lowering Cholesterol Naturally Through Diet
Dietary changes are the key for managing cholesterol. You won’t read much in this article about lowering cholesterol with exercise because it’s just not that effective. I’m not saying it’s not a good idea, I just don’t recommend using exercise to lower your cholesterol. You’ll be disappointed with the results.
All too often patients who find out they have high cholesterol jump on the exercise bandwagon and make only token changes to their diet. This thinking is wrong. There are a few simple dietary changes that can pay huge dividends in lowering your cholesterol and lowering your risk of a heart attack or stroke.
Dietary Fat Changes (aka the Myth of High Cholesterol Foods)
Dietary fat plays a strong role in maintaining optimal cholesterol levels. The 80s and 90s USDA dietary guidelines created an entire generation that believed the equation that fat = fattening. Thus began the increasing waistlines of the American public and the increasing rates of diabetes and most cancers.
The type of fat is the most important factor when it comes a healthy lifestyle. Monounsatured fats and omega 3 fatty acids are fats found in food items like nuts, seeds, olive oil, grass fed beef (grass-fed through the entire life cycle, NO grain-finishing), wild game and avocados are great sources of healthy fats that you can and should be eating on a regular basis.
Omega-6 fatty acids, on the other hand, are consumed far too often in industrialized nations. Think of oils like sunflower, cottonseed, corn and soybean oil—these are all high in omega-6 fats. These fats are in so many of the unhealthy snacks that society craves like chips, French fries and processed foods. Cutting back on your intake of these foods is always a good thing.
Hydrogenated oils frequently go hand in hand with omega-6 fatty acids. Hydrogenated oils are created through a chemical process that turns oils that are a liquid at room temperature (bad for shelf life and storage) into solids at room temperature. Think “fake” peanut butter that has a near-indefinite shelf life compared to real peanut butter that goes bad in a couple of days outside of the refrigerator. These hydrogenated oils will absolutely raise your cholesterol levels.
But what about reducing dietary cholesterol? The crazy, unguided focus on dietary cholesterol that was the foundation of dietary recommendations did very little to help anything. The levels of cholesterol in your body is only about 20% due to your dietary intake. The vast majority of the cholesterol in your body comes from an enzyme called HMG-CoA reductase—the enzyme that statin drugs affects.
And the biggest driver of this enzyme?
Carbohydrates and Cholesterol
The scourge of society. The focus of many of the current dietary recommendations for weight loss popular at the time of the writing of this article.
It’s not that carbs are bad, but there are certainly grave concerns with the types of carbohydrates that society consumes. Enriched wheat flour should have been banned decades ago, but the companies that thrive on products containing this toxic compound has far more political power than the groups that promote whole grains and healthy lifestyles.
Think of the major confectionary companies like Kellogg’s, Quaker, Nabisco and Kraft. If these companies removed the products that contained enriched wheat flour and hydrogenated oils I’m pretty sure the products lines would be devastated.
When I talk to patients, I recommend keeping carb intake lower, and any carbs that are consumed should be in the form of whole grains, fruits and vegetables. Enriched wheat flour is to be avoided like the plague.
Broadening your exposure to different types of grains is important as well; wheat predominates the grains eaten and yet other grains like quinoa, teff and salvia have a very strong nutritional quality but are seldom eaten. These grains also do not contain gluten, which is its own topic and beyond the scope of this article.
One thing is clear, carbohydrate intake, in almost all forms, will drive cholesterol numbers up. Some more (like enriched wheat flour) and some less (like ancient whole grains free of gluten). Staying conscious of your overall carb intake (both grams of and types of) and lowering it when possible needs to be on the agenda.
As a side note, stick with organic grains as much as possible. There are concerns over the use of glyphosate from the herbicide Roundup, found in very high levels in non-organic grains (especially wheat). This toxic chemical has been implicated in conditions as far-reaching as cancer, infertility, diabetes, thyroid dysfunction and gut issues.
As a second side note, you can NOT lower your carb intake by switching to artificial sweeteners like Splenda (sucralose), Nutrisweet (aspartame) and acesulfame potassium / K. These are absolutely, positively off the list, even in the smallest amounts. No exceptions.
Proteins and Cholesterol Levels
Switching to a higher intake of proteins is going to be the hallmark of a cholesterol reduction program, but the type of proteins you take in is going to be critical.
It is very clear that a higher intake of animal-based proteins is going to contribute to cancer growth (as based on the results from the China Study and others), so searching for palatable source of plant-based proteins is important.
Animal based proteins, when taken in, should be of the highest quality (organic, wild game, grain-fed and finished) and smaller quantities. The smaller quantity is the biggest challenge for most of you reading this. The 32 ounce porterhouse is no longer an option. On the other hand 3 or 4 ounce portions of organic grass-fed and finished beef is acceptable for an evening meal when accompanied by a decent sized portion of vegetables. The same could apply for organic chicken.
For plant-based protein ideas, consider these options:
- Organic peanut butter and other nut butters
- Organic edamame and tofu
- Pea or rice based protein powders (NO artificial sweeteners in the mix)
- Quinoa and other ancient grains
There are additional options besides those that I’ve listed here; you just have to get creative and adventurous.
But overall you get the idea—higher protein intake, but this protein intake needs to be predominately plant-based with a mix of organic, high quality animal based proteins.
If you have cholesterol issues, regardless of whether it relates to lower good (HDL), high triglycerides, high bad (LDL) or high VLDL—all of these recommendations apply and will help you in your goal of lowering your cholesterol naturally.
Cholesterol lowering drugs are never a good idea. Not only do they not fix the problem creating the cholesterol issues but they create a very long list of side effects that, in most cases, leave you worse off then you were before taking them.
Lifestyle is the ONLY way to really lower your cholesterol safely and protect your heart and brain at the same time. Everything else is just smoke and mirrors.
If this little article is not nearly enough for your brain, my Cholesterol Lowering eBook is loaded with far more detail and information. Feel free to check it out on Amazon by clicking here.
For the rest of you, let me know in the comments what helped YOU to lower your cholesterol.