The Great Cholesterol Myth: Why Lowering Your Cholesterol Won't Prevent Heart Disease--and the Statin-Free Plan that Will

by Jonny Bowden

A classic 1992 study examined the blood work of healthy centenarians in an effort to find out whether there were any commonalities among the members of this unusually long-lived demographic. It found three: low triglycerides, high HDL cholesterol, and—wait for it—low fasting insulin.4 Your diet affects two of these blood measures—triglycerides and fasting insulin—and both measures will fall like a rock when you reduce or eliminate sugar and processed carbs in your diet.

In our opinion, lowering triglycerides is one of the major health benefits of a diet lower in sugar, as high triglycerides are far more of a danger sign for heart disease than high cholesterol is.

Having insulin resistance is a tsunami when it comes to developing heart disease. Insulin resistance makes it more likely you’ll have hypertension, puts you at significantly greater risk for diabetes, is almost certainly correlated with elevated triglycerides, and is heavily correlated with obesity—all major risk factors for cardiovascular disease. But to add insult to injury, that excess insulin has an inflammatory effect on your system as well.

The collection of diseases strongly influenced by insulin resistance has been given the acronym CHAOS: coronary disease, hypertension, adult onset diabetes, obesity, and stroke. They’re all related, and what they have in common is insulin resistance.

The higher your triglycerides, the greater the chance that you’re insulin resistant. This in turn means that insulin is contributing mightily to the very inflammation that damages LDL cholesterol in the first place and starts the whole cycle of plaque formation. The take-home point: Reduce your triglycerides (and raise your HDL), and you reduce your risk of heart disease.

By mixing together more salt, more fat, more flavorings, and—importantly—more sugar than any food in nature could possibly produce, they’ve created products that virtually light up the dopamine and opioid pathways in our brain. Those are the very same pathways activated by recreational drugs. Indeed, some research has shown that sugary foods have an even more intense effect on the brain’s reward pathways than cocaine.

Don’t let anyone trick you into thinking sugar is fine as long as you don’t eat too much. “Just a little sugar” might not do as much damage as eating a ton of it—but the caveat is, most of us can’t ever stop at “just a little.”

A far more powerful contributor to heart disease is sugar. (And, of course, the insulin resistance that can results from eating too much of it!) Diets that are lower in sugar and processed carbs will reduce inflammation, blood sugar, insulin, insulin resistance, and triglycerides. And lowering triglycerides automatically improves that all-important ratio of triglycerides to HDL.

“High blood sugar causes the lining cells of the arteries to be inflamed, changes LDL cholesterol, and causes sugar to be attached to a variety of proteins, which changes their normal function,” says Dwight Lundell, M.D., author of The Cure for Heart Disease.

he pointed to a number of studies—most dramatically of the Masai in Kenya and Tanzania—in which people consumed copious amounts of milk and fat and yet had virtually no heart disease. Interestingly, these people also consumed almost no sugar.

Higher triglycerides are an independent risk factor for heart disease—and raising them while lowering HDL cholesterol at the same time is a double whammy,

Fructose is the damaging part of sugar, and whether you get that fructose from regular sugar or from HFCS doesn’t make a whit of difference. That doesn’t absolve HFCS at all; it just means that “regular” sugar is virtually just as bad as HFCS. It’s the fructose in each of them that’s causing the damage,

Fructose is the major cause of fat accumulation in the liver, a condition known technically as hepatic steatosis but which most of us know as fatty liver. And there is a direct link between fatty liver and our old friend, insulin resistance.

Sugar is the missing link among diabetes, obesity, and heart disease. It overrides our body’s natural hunger regulation, making it very easy to overeat. It is also a major contributor to inflammation in the artery walls.

Hypertension, high triglycerides, and a high ratio of triglycerides to HDL are all better predictors of heart disease than cholesterol. Sugar, or more specifically fructose, raises every single one them.

High levels of both sugar and insulin damage LDL particles in the blood, making them far more likely to end up incorporated into arterial plaque.

The problem with vegetable oils is that they’re nowhere near as resistant to damage as saturated fats are. When you heat and reheat them for frying, as virtually every restaurant in America does, it causes the formation of all sorts of noxious compounds, including carcinogens.

the above meta-analysis didn’t just look at cholesterol levels; it looked at what we really care about—heart disease and dying. So never mind whether saturated fat raises my cholesterol level. What I really want to know is, does eating saturated fat increase my chances of getting a heart attack or not? The meta-analysis looked at exactly that real-life endpoint we truly care about, and on that all-important metric, the verdict was clear. Saturated fat in the diet has virtually no effect on your risk of dying from a heart attack.

A 2015 meta-analysis published in the British Medical Journal found that “Saturated fats are not associated with all-cause mortality CVD, CHD, ischemic stroke, or type 2 diabetes.”

when saturated fat was replaced with polyunsaturated fat, there was a big change—but not in the expected direction. Replacing saturated fat with polyunsaturated fat actually led to an increase in the progression of coronary atherosclerosis!

refined carbohydrates and their high glycemic load were independently shown to be associated with an increased risk for coronary heart disease.

If you wanted to swap some saturated fat out of your diet and trade it for some low-sugar, high-fiber, nutrient-rich carbohydrates, such as Brussels sprouts or kale, no one would complain. Substituting saturated fat with low-glycemic carbs such as vegetables doesn’t increase the risk of heart attacks at all, but substitution of saturated fat with high-glycemic carbs does—by a fair amount, actually.

A study in the American Journal of Clinical Nutrition found that replacing saturated fats with high-glycemic index carbs was associated with a 33 percent increase in heart attack risk.21 Because most people replace saturated fat with exactly these kinds of processed, high-glycemic (high-sugar) carbs (e.g., breads, cereals, and pasta), the conventional wisdom to cut out saturated fat and consume lots of carbs instead is starting to look like an increasingly boneheaded notion.

Here’s what Seneff told us about statin drugs when we contacted her for this book: “Statin drugs are toxic. I liken them to arsenic, which will slowly poison you over time.”

Seneff has become one of the most respected and outspoken critics of the cholesterol hypothesis, and she is quite vocal about her opposition to statin drugs, which she believes are the next medical tragedy waiting to happen.

Let’s be clear: Although Seneff and other independent researchers are pretty unequivocal in their negative appraisal of statin drugs, we are not—we’re a little more moderate. Neither of us believes that statin drugs are all bad. As mentioned earlier, Steve still prescribes them very occasionally, in certain limited circumstances (i.e. to middle-aged men who have had a previous heart attack and are at high risk for a second).

Statin drugs do some good in some circumstances, but their benefits, and the circumstances in which they are appropriate, are much more limited than the pharmaceutical companies—and the doctors who buy into their talking points—would have us believe.

Smith and Pinckney reviewed all of the cholesterol-lowering trials that had been done before 1991. The studies found that using drugs to lower cholesterol was quite effective—at lowering cholesterol. The problem was that they weren’t much good for anything else—for example, saving lives. If cholesterol lowering was in fact the holy grail of preventing heart disease and death, then we would expect the research to show a reduction in heart attacks, strokes, and deaths when cholesterol was effectively lowered, wouldn’t we?

Here’s what Smith and Pinckney concluded: In the vast majority of the studies reviewed, there was no difference in the number of deaths between the group that lowered its cholesterol and the group that didn’t.

As Smith and Pinckney conclusively demonstrate, all thirty or so studies completed before 1990 showed that you could lower cholesterol to your heart’s content without adding a single day to your life. John Abramson, M.D., a professor of medicine at Harvard Medical School and the author of Overdosed America, summed up the problem perfectly in the medical journal The Lancet: “You can lower cholesterol with a drug, yet provide no health benefits whatsoever. And dying with corrected cholesterol is not a successful outcome.”

Besides being far less effective than you’ve been led to believe, statins have myriad unpleasant, and in some cases acute—or even fatal—side effects, such as many of those Seneff’s husband experienced. These include muscle pain, weakness, fatigue, memory and cognition problems, and—for a large number of people—very serious problems with sexual functioning.

Without cholesterol, brain cells can’t effectively “talk” to each other, cellular communication is impaired, and cognition and memory are significantly affected, usually not in a good way!

Speaking at a luncheon discussion put on by Project A.L.S.—a nonprofit dedicated to raising money for brain research and the understanding of Lou Gehrig’s disease—the vice chairman of medicine at New York Presbyterian Hospital, Orli Eingin, M.D., had this to say regarding the number-one-selling statin drug in the world, Lipitor: “This drug makes women stupid.”

The severe reduction in CoQ10 caused by statin drugs damages not only the heart but also the skeletal muscles that rely on CoQ10 for energy production. How ironic that a drug given to prevent heart disease—which it barely does, and then only in extremely limited circumstances—substantially weakens the very organ it’s meant to protect!

Erectile dysfunction affects more than half of all men between the ages of forty and seventy years.13 We’ve already seen how lowering cholesterol can have serious consequences for memory, thinking, and mood. Just as the brain needs cholesterol for neurotransmitters to properly function, the gonads need it to produce the hormonal fuel to keep our sex lives humming. All the major sex hormones—testosterone, progesterone, and estrogen—come from cholesterol. It’s utterly preposterous to assume that lowering cholesterol, which is tantamount to downsizing your body’s own sex hormone factory, is not going to have a profound effect on sexual functioning. Of course it is. And it does.

Dr. Sinatra will frequently prescribe a low-dose statin drug for people in this specific population: middle-aged men who have already had a heart attack or have documented coronary artery disease. Both of us believe there is no other good use for statin drugs*. There is virtually no good evidence to support their use in women,12 they do not need to be prescribed for people who have not had a heart attack, and they definitely—emphatically, positively—should not be prescribed for children.

research has convincingly demonstrated that serotonin receptors can be rendered dysfunctional by statin drugs.

Statins can potentially promote cancer through a variety of mechanisms: one, through reductions in natural killer cell cytotoxicity (which, over time, decrease the body’s immune response to tumor cells); two, through increases in endothelial progenitor cells in the bone marrow (which are associated with invasive breast cancer and lymphoma, and can potentially feed tumors by supporting new blood vessel growth); and three, by increasing the numbers and functionality of regulatory T-cells (which can impair the body’s immune response against tumors and decrease the effectiveness of cancer immunotherapy).

In the ALLHAT study, there was ultimately no difference in the death rate from heart attacks between the statin-treated group and the no-statin group. Not a single life was saved by statins.

What’s more, critics of the study pointed out a trend toward higher rates of heart failure, diabetes, and kidney impairment in the Lipitor-treated group.

A few years ago, John Abramson, M.D., author of Overdosed America, analyzed eight randomized trials that compared statin drugs with placebos. His findings and conclusions were published in a column in The Lancet. Here’s what he wrote: “Our analysis suggests that … statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years"

Insulin resistance is to heart disease what smoking is to lung disease.

Get to know insulin—it’s more important to your health and your heart than you can imagine, and way more important than your doctor has probably told you.

“Emerging evidence shows that insulin resistance is the most important predictor of cardiovascular disease and type 2 diabetes,” says Robert Lustig, M.D., the pediatric endocrinologist and professor in the Department of Endocrinology at University of Southern California, San Francisco.

In 1988, a brilliant Stanford University medical professor and researcher named Gerald Reaven noticed that insulin resistance was almost always at the center of a cluster of conditions that, together, greatly increased the risk for cardiovascular disease: high blood pressure, abdominal obesity, low HDL cholesterol, and high triglycerides. Any of those conditions alone is a risk factor for heart disease, but together—with insulin resistance at the core—they were even more ominous.

not long afterwards it became known as metabolic syndrome, and later, as pre-diabetes. Many researchers are now calling this syndrome—correctly in our view—insulin resistance syndrome. Over half of U.S. adults have it. And yes, you should be worried.

They noted that insulin resistance leads to the well-known lipid triad: (1) high levels of triglycerides, (2) low levels of HDL and (3) small, dense LDL particles.

To make matters worse, insulin resistance is also linked to obesity, which, in turn, is associated with a higher risk of cardiovascular disease (CVD).

According to the data about 65 percent of U.S. adults over forty-five are pre-diabetic or diabetic—and many suspect that’s an understatement. After all, those conclusions are based on blood sugar readings, not direct measures of insulin, nor of insulin resistance. Unfortunately, high blood sugar is a late sign of problems.

what we’re always surprised by is heart disease in a person of normal weight who seems to be doing everything right. He’s not overweight, he doesn’t smoke, he’s not downing a dozen cans of sweetened sodas … but yet under the hood, he’s aging rapidly due, largely, to undiagnosed insulin resistance and the metabolic damage it leaves in its wake.