Bishop Hill Academic science: not fit for purpose
Dec 16, 2014 Books Sui generis 
Richard Smith has another fascinating article about the way science has been practised in universities in recent decades, focusing particularly on The Big Fat Surprise, a book about the purported links between diet and health. It's full of quotable stuff; so much so that I barely know where to begin, but this, almost at random, gives a flavour of the thing.
[Ancel Benjamin Keys, a biologist at the University of Minnesota] studied few men and did not have a reliable way of measuring diets, and in the case of the Japanese and Italians he studied them soon after the second world war, when there were food shortages. Keys could have gathered data from many more countries and people (women as well as men) and used more careful methods, but, suggests Teicholz, he found what he wanted to find. A subsequent study by other researchers of 22 countries found little correlation between death rates from heart disease and fat consumption, and these authors suggested that there could be other causes, including tobacco and sugar consumption
Great stuff. The wider point though is how this mirrors stories familiar to BH readers: how challenges to the dodgy science were dealt with
Keys dismissed [the counterhypothesis] as a “mountain of nonsense” and a “discredited tune.”
...how politicians took it in unquestioningly
One congressional staffer, Nick Mottern, wrote a report recommending that fat be reduced from 40% to 30% of energy intake, saturated fat capped at 10%, and carbohydrate increased to 55-60%.
...how corporate interests took advantage:
It might be expected that the powerful US meat and dairy lobbies would oppose these guidelines, and they did, but they couldn’t counter the big food manufacturers such as General Foods, Quaker Oats, Heinz, the National Biscuit Company, and the Corn Products Refining Corporation, which were both more powerful and more subtle.
and how the consequences were less than benign:
The successful attempt to reduce fat in the diet of Americans and others around the world has been a global, uncontrolled experiment, which like all experiments may well have led to bad outcomes. What’s more, it has initiated a further set of uncontrolled global experiments that are continuing.
This all sounds very familiar. What you can see here is yet another example of academic science proving inadequate for informing public policy, serving up results that are half-baked, half-tested, and often already half refuted. When will politicians learn?
Reader Comments (67)
Some have mentioned Gary Taubes, and his book Good Calories Bad Calories is an exhaustive survey of the way politicized science institutions have failed to practice good science at even a basic level. Tons of parallels for the AGW story.
More important though is the fact that he and Peter Attia have decided to do something about the problem of science itself, by finding a way of funding and managing quality studies. They founded nusi.org (see website by that name) with the goal of getting principled, principal investigators with different opinions on the likely outcome to design studies that they all agree are properly designed, and then raising funds from non-government sources.
If they succeed in this effort they may be showing a path that can save science.
I bet Mr Azlac's 50 years felt like 150. It reminds me of W.C Fields abjuring drink and fine foods for a time; he reported he lost 2 weeks.
Then you would lose the bet. I live in the Mediterranean and consume a traditional Mediterranean diet based on high quality fresh foods – eggs, meat, pasta, fish and shellfish vegetables and fruits. My hoby is cooking and I like good food but cannot afford the high class restaurants that serve it so I make my own. Italian cooking at its best is some of the finest in the World – the French got their skills from a Borgia marrying into the French royalty – and this is based on the use of butter, cream and olive oil etc – look up a good Italian cookbook like the Silver Spoon and you will get the message.
Peter Azlac: "This involves appetite control"
Low carb = appetite control for me
“Weight loss was greater in the low-carbohydrate group than in the low-fat group at 3, 6, and 12 months.”
The point that I made in my comment is that weight loss is all about restricting caloric intake and this can be a achieved in several ways: through a ketogenic high fat/protein diet like Atkins, Dukan South Beach etc; through social eating like in the traditional Italian family where there are several dishes – pasta, meat, vegetable, cheese that are eaten during discussions at the table and so give the brain a chance to signal the stomach that satiety has been reached; or the use of diets of low glycaemic value that limit the speed of uptake of glucose from the gut so preventing the adverse insulin response that leads to the metabolic syndrome.
If you go for the low carbohydrate route then you will lose weight more rapidly because glucose is stored as glycogen and involves water so losing glycogen means losing body water, hence higher weight loss. But the problem with this is that your brain has a high demand for glucose and if not enough is supplied it takes its energy from ketones that arise from the breakdown of fat and apart from the bad breath this does not help your thinking process and worse still in diabetics can lead to death from ketoacidosis.
The other problem with this route is that your metabolic rate depends on muscle mass and muscles require glucose for short term heavy activity but use fatty acids for endurance work and the use of fatty acids requires a supply of glucose – the usual nutritionist statement is that fat burns in a flame of carbohydrate. To find this glucose the body breaks down muscle protein and so you lose muscle mass and in the longer term more weight but your metabolic rate has dropped – that is why typically after a year on a Atkins type diet the lost weight is restored and more so. This is not a voice from authority but from practical experimentation – for example, Professor Joseph Donnelly at the University of Kansas carried out a calorimetric study with identical twins - this involves a sealed, insulated chamber (closed circuit calorimeter) where all the heat, carbon dioxide and other waste products are balanced against the food and oxygen consumed to arrive at an exact energy balance. Over a period of two weeks, the twins received isocaloric diets: one a low-fat diet and the other the Atkins high-protein/high-fat diet. At the end of the period, the measurements confirmed the earlier studies of Yudkin and others – the twin on the Atkins diet lost only 22 kcal. There are numerous other trials with similar results. So the choice is yours, use a high fat diet to control caloric intake and achieve a high weight loss including muscle mass with resulting health risks down the line or a balanced high fibre, high carbohydrate diet, like the Mediterranean diet, that achieves the same ends via the use of products of low glycaemic value with none of the same downsides, in fact such diets have been used to reverse heart disease.
High fibre does not mean the consumption of high bran type fibre but rather the soluble fibre found in beans and other products that form gels in the intestine and control the uptake of glucose. Of equal importance is that one does not consume oils like maize oil that are low in the omega3 and omaga 6 fatty acids needed for correct cell formation and function and as are certain levels of saturated fatty acids. I have long spoken against the cholesterol meme – I wrote a book on this in the 1990;s that I could not get published as it went against the current consensus – but there are two forms of cholesterol that are dangerous, the very small VLDL particles that get lodged in cracks in the arterial wall and the oxidized cholesterol from egg powder found in many confectionary products. But the cracks only appear if the cells are formed from the wrong fatty acids – trans fatty acids from margarine etc – and there is a lack of anti oxidants in the diet. The form of iron in red meat is a particularly strong oxidant and if not countered with sufficient anti oxidant cause arterial damage. So an adequate diet would be around 65% carbohydrate of low glycaemic value and high fibre content, 15% of high quality protein from fish, eggs and dairy products and the remaining 20% as fat from sources high in omega 3 and omega 6 fatty acids plus saturated fat to balance from butter, cheese and other animal fats. This is a typical Mediterranean or Korean diet that that is not the least boring to consume.
Finally the claims made by Taube and others that the health problems in the USA arise from a change from a high fat diet to a high carbohydrate are not supported by the facts. I do not have the latest data to hand but between 1969 and 1992 when the Ancel Keys hysteria was at its highest the number of calories consumed by Americans increased by 12% or 500 kcals on top of an already high value of 3220 kcals – the norm for a sedentary person is around 2400 kcals. This increase came from fat (+11% ) and protein (+12%) but the damage came from a switch from animal fat to oilseeds, especially corn oil that has a limiting effect on cell function as it does not provide a balanced supply of fatty acids. See the Oiling of America:
https://www.youtube.com/watch?v=fvKdYUCUca8
More damaging was the switch from sugar as sucrose to fructose syrup derived from corn – in high amounts this has a damaging effect on liver function and since it is now present in most manufactured foodstuffs and soft drinks, especially power drinks it has been isolated as the major cause of obesity.
http://www.lef.org/magazine/2008/12/metabolic-dangers-of-high-fructose-corn-syrup/Page-01
I bet Mr Azlac's 50 years felt like 150. It reminds me of W.C Fields abjuring drink and fine foods for a time; he reported he lost 2 weeks.
Then you would lose the bet. I live in the Mediterranean and consume a traditional Mediterranean diet based on high quality fresh foods – eggs, meat, pasta, fish and shellfish vegetables and fruits. My hoby is cooking and I like good food but cannot afford the high class restaurants that serve it so I make my own. Italian cooking at its best is some of the finest in the World – the French got their skills from a Borgia marrying into the French royalty – and this is based on the use of butter, cream and olive oil etc – look up a good Italian cookbook like the Silver Spoon and you will get the message.
Peter Azlac: "This involves appetite control"
Low carb = appetite control for me
“Weight loss was greater in the low-carbohydrate group than in the low-fat group at 3, 6, and 12 months.”
The point that I made in my comment is that weight loss is all about restricting caloric intake and this can be a achieved in several ways: through a ketogenic high fat/protein diet like Atkins, Dukan South Beach etc; through social eating like in the traditional Italian family where there are several dishes – pasta, meat, vegetable, cheese that are eaten during discussions at the table and so give the brain a chance to signal the stomach that satiety has been reached; or the use of diets of low glycaemic value that limit the speed of uptake of glucose from the gut so preventing the adverse insulin response that leads to the metabolic syndrome.
If you go for the low carbohydrate route then you will lose weight more rapidly because glucose is stored as glycogen and involves water so losing glycogen means losing body water, hence higher weight loss. But the problem with this is that your brain has a high demand for glucose and if not enough is supplied it takes its energy from ketones that arise from the breakdown of fat and apart from the bad breath this does not help your thinking process and worse still in diabetics can lead to death from ketoacidosis.
The other problem with this route is that your metabolic rate depends on muscle mass and muscles require glucose for short term heavy activity but use fatty acids for endurance work and the use of fatty acids requires a supply of glucose – the usual nutritionist statement is that fat burns in a flame of carbohydrate. To find this glucose the body breaks down muscle protein and so you lose muscle mass and in the longer term more weight but your metabolic rate has dropped – that is why typically after a year on a Atkins type diet the lost weight is restored and more so. This is not a voice from authority but from practical experimentation – for example, Professor Joseph Donnelly at the University of Kansas carried out a calorimetric study with identical twins - this involves a sealed, insulated chamber (closed circuit calorimeter) where all the heat, carbon dioxide and other waste products are balanced against the food and oxygen consumed to arrive at an exact energy balance. Over a period of two weeks, the twins received isocaloric diets: one a low-fat diet and the other the Atkins high-protein/high-fat diet. At the end of the period, the measurements confirmed the earlier studies of Yudkin and others – the twin on the Atkins diet lost only 22 kcal. There are numerous other trials with similar results. So the choice is yours, use a high fat diet to control caloric intake and achieve a high weight loss including muscle mass with resulting health risks down the line or a balanced high fibre, high carbohydrate diet, like the Mediterranean diet, that achieves the same ends via the use of products of low glycaemic value with none of the same downsides, in fact such diets have been used to reverse heart disease.
High fibre does not mean the consumption of high bran type fibre but rather the soluble fibre found in beans and other products that form gels in the intestine and control the uptake of glucose. Of equal importance is that one does not consume oils like maize oil that are low in the omega3 and omaga 6 fatty acids needed for correct cell formation and function and as are certain levels of saturated fatty acids. I have long spoken against the cholesterol meme – I wrote a book on this in the 1990;s that I could not get published as it went against the current consensus – but there are two forms of cholesterol that are dangerous, the very small VLDL particles that get lodged in cracks in the arterial wall and the oxidized cholesterol from egg powder found in many confectionary products. But the cracks only appear if the cells are formed from the wrong fatty acids – trans fatty acids from margarine etc – and there is a lack of anti oxidants in the diet. The form of iron in red meat is a particularly strong oxidant and if not countered with sufficient anti oxidant cause arterial damage. So an adequate diet would be around 65% carbohydrate of low glycaemic value and high fibre content, 15% of high quality protein from fish, eggs and dairy products and the remaining 20% as fat from sources high in omega 3 and omega 6 fatty acids plus saturated fat to balance from butter, cheese and other animal fats. This is a typical Mediterranean or Korean diet that that is not the least boring to consume.
Finally the claims made by Taube and others that the health problems in the USA arise from a change from a high fat diet to a high carbohydrate are not supported by the facts. I do not have the latest data to hand but between 1969 and 1992 when the Ancel Keys hysteria was at its highest the number of calories consumed by Americans increased by 12% or 500 kcals on top of an already high value of 3220 kcals – the norm for a sedentary person is around 2400 kcals. This increase came from fat (+11% ) and protein (+12%) but the damage came from a switch from animal fat to oilseeds, especially corn oil that has a limiting effect on cell function as it does not provide a balanced supply of fatty acids. See the Oiling of America:
https://www.youtube.com/watch?v=fvKdYUCUca8
More damaging was the switch from sugar as sucrose to fructose syrup derived from corn – in high amounts this has a damaging effect on liver function and since it is now present in most manufactured foodstuffs and soft drinks, especially power drinks it has been isolated as the major cause of obesity.
http://www.lef.org/magazine/2008/12/metabolic-dangers-of-high-fructose-corn-syrup/Page-01
History of the low-fat ‘diet-heart’ hypothesis.
The vilification of saturated fat by Keys2 began two decades before the seven countries study, where Keys showed a curvilinear association between fat calories as a percentage of total calories and death from degenerative heart disease from six countries. However, he excluded data from 16 countries that did not fit his hypothesis. Indeed, data were available at the time from 22 countries, and when all countries were looked at the association was greatly diminished.3 Furthermore, no association existed between dietary fat and mortality from all causes of death.3 Thus, past data promoted by Keys showing that an increased percentage of fat calories consumed increases the risk of death are not valid (and certainly could never have proved causation). These data seemingly lead us down the wrong “dietary-road” for decades to follow, as pointed out by others.4 ,5
Lack of evidence for a low-fat diet.
Data are lacking in the support of a low-fat diet. In the low-fat diet in myocardial infarction trial, a controlled trial was performed to test if a low-fat diet would improve outcomes in 264 men who had recently recovered from a first myocardial infarction.32 Despite the fact that patients in the low-fat diet group ate significantly less fat (45 g/day vs 110–130 g/day), consumed less calories (approximately 1950 calories vs 2450 calories), obtained a lower cholesterol level and achieved a greater fall in body weight than those in the control group, there was no difference in definite reinfarction or death.
In the Women's Health Initiative (WHI), a randomised controlled trial including 48 835 postmenopausal women, a low-fat diet was not shown to reduce coronary heart disease, stroke or cardiovascular disease,33 despite a significant reduction in LDL-C, nor was there a reduction in cancer.34 ,35 A meta-analysis by Siri-tarino et al36 consisting of 21 prospective epidemiological studies, derived from 347 747 participants, indicated that the intake of saturated fat does not increase coronary heart disease or cardiovascular disease. Moreover, a recent Cochrane meta-analysis indicated that changing dietary fat intake does not affect total mortality or cardiovascular mortality.37 Although reducing saturated fat was associated with a reduced risk of cardiovascular events by 14%, this was not shown with reducing total fat consumption.37 While the WHI study and the Siri-tarino and Cochrane meta-analyses cannot be taken at face value, taken together with “the low-fat diet in myocardial infarction trial”, a compelling argument can be made for the general lack of evidence in support of a low-fat diet. Dietary recommendations based on evidence from the literature are summarised in box 2.
Read the rest at http://openheart.bmj.com/content/1/1/e000032.full?sid=5e6b0cad-75ea-41a1-85e6-e5461d77846c
Azlac, a major portion of Teicholz's book is devoted to how the so-called Mediterranean Diet was hyped in pursuit of vilification of dietary saturated fat. It has its roots in the romanticism of traditional diets. Such hype helps pasta sales, that's all. As for French marriages and cultural transmission, Jonathan Jones and I ran into the Wikipedia entry for Turkey where it said country's cuisine was 'the best in the world'. Jones got the entry corrected.
Wikipedia now informs the UNESCO recognized, during its meeting in Baku the [Mediterranean] diet pattern as an Intangible Cultural Heritage of Italy, Portugal, Spain, Morocco, Greece, Cyprus and Croatia. Why you could say for almost every geographic region in the world isn't it? 'The UNESCO recognizes the Inuit diet pattern as an intangible cultural heritage of the Arctic region, the UNESCO recognizes the Chinese diet pattern as an intangible cultural heritage of China, and so on'.
Calorie counting doesn't work. This is what I meant by experimentation. Try to count calories and eat carbohydrate-rich food - you won't lose weight. Calorie counting is only true in a very macro sense - if you eat calorie-rich food, especially carbohydrate-containing food in 'excess' consistently you can put on weight. Beyond such simplifications all bets are off. The obesity epidemic is multifactorial and not a direct consequence of caloric excess alone. Likewise, within an individual, several factors control body weight and some of these are far more difficult to modify compared to dietary constituents - like baseline appetite and the hypothalamic set point. Just like the magical number 2400, similar numbers have been pushed for sodium and cholesterol and are currently in the process of being abandoned. Your 65% carbohydrate advice is enshrined in public health policy, including in the food pyramid. The effects are all around us to be seen.
Beyond that your statements on diabetic ketoacidosis and the importance of oxidants and anti-oxidants are simply wrong.
"Calorie counting doesn't work. This is what I meant by experimentation. Try to count calories and eat carbohydrate-rich food - you won't lose weight. Calorie counting is only true in a very macro sense - if you eat calorie-rich food, especially carbohydrate-containing food in 'excess' consistently you can put on weight."
I did not propose calorie counting, what I said is that caloric intake is what controls weight and of course different persons have different metabolic rates, mostly linked to exercise and especially muscle mass. There is some evidence to support a genetic link but it is far from established. What I pointed out is the methods that can be used to control caloric intake through satiety by manipulating the factors that affect appetite and this can be done simply and effectively.
You equate a high carbohydrate diet with a high calorie diet but in fact that is a high starch diet which is quite different from one containing large amounts of structural carbohydrate - from vegetables, frutis and whole grains, hence the fibre comment. As to the Mediterranean diet being hyped to promote sales of pasta that is an advertising misuse of the information much like a lot of the advertising of low fat or low carbohydrate diets. I live in Scandinavia and in the Mediterranean and for example the French and Finns consume similar amounts of saturated fat as dairy products but the French consume it more as butter and fats such as goose fat. The Finns at the time of Ancel Keys had the highest level of heart disease in the Western world whereas the French had one of the lowest, but not as low as Crete or Japan. This shows that using a simple measure such as saturated fat intake, as did Ancel Keys to claim it was a cause of heart disease was flat out wrong. We now know that the difference is that Scandinavians consume less magnesium as the water comes off granite compared to dolomite in the Mediterranean areas and that the lack of sunlight up north results in inadequate intakes of vitamin D. So of course I am well aware that there are multi factor effects related to weight and health but to claim that a high fat diet is healthier and controls weight better than a low fat high structural carbohydrate low glycaemic diet is plain rubbish and not supported by the experimental evidence you cite only hearsay.
"Beyond that your statements on diabetic ketoacidosis and the importance of oxidants and anti-oxidants are simply wrong."
The mote is in your eye, try looking up references on ketosacidosis and diabetes, you can start with this one but there are may others:
http://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/basics/definition/con-20026470
Similarly the importance of antioxidants in preventing cellular damage from free radicals. Again try this reference but there are many more:
http://www.rice.edu/~jenky/sports/antiox.html
One last comment, I am a scientist and as such a sceptic who requires evidence of claimed effects and not a consensus view. It is not nutritionists, except Ancel Keys and a few others, that pushed the cholesterol-saturated fat myth but like climate change big business, especially the oilseed and grains industries that marketed the myth with direct help from the American Heart Association that they controlled and of course, as with Climate Change, politicians who were bought. As with climate change, there is currently no consensus among nutritionists to push low carbohydrate diets, rather for people to consume balanced diets in moderation and high fat / high protein diets do not meet that standard, especially when they are based on vegetable oils of the wrong fatty acid composition that are loaded with free radicals from oxidation and consumed alongside proteins of low amino acid value.
peter, when you wrote:
"But the problem with this is that your brain has a high demand for glucose and if not enough is supplied it takes its energy from ketones that arise from the breakdown of fat and apart from the bad breath this does not help your thinking process and worse still in diabetics can lead to death from ketoacidosis."
did you mean to imply that if diabetics don't get glucose they could die from ketoacidosis?
That is how your argumentation is constructed: you start by listing some of the ill effects of 'the low-carbohydrate route' and you concluded by saying people could die from ketoacidosis.
Not only is the larger portrait wrong but so is the simplistic and imcomplete summarization of ketoacidosis in diabetes. Is this what you wanted to say? 'Cause internet comments are short and things don't come out exactly the way it should. I know I'm guilty of that all the time.
Peter Azlac
When most people who have discovered the benefits of disregarding the food pyramid advocated the last fifty years say "low carb" they most likely mean cut bread, pasta, other wheat junk and cereal junk, and reduce spuds. They end up eating lots of vegetables, meat, eggs, fish, salads and a bit of fruit.
That's how I started two years ago, now down twenty kilos. I eat plenty of carbs as pumpkin, parsnip, sweet potato. In my case the problem seems to be wheat and sugar. This may not be the case for everyone.
I have exercised no appetite control whatever, just ingredient control.
If you don't eat fat or protein you will die; but we can survive quite happily without carbohydrates - and the brain copes just fine, thanks to gluconeogenesis. Indeed, induced ketosis is a recognised treatment for epilepsy. Ketosis is just the body's fat burning state. Conflating this with ketoacidosis in diabetics is somewhat tricksy, to say the least.
I love food threads - maximum woo!
In fact, the "science" of nutrition is even more primitive than so called climate "science." Superfoods, anyone? Five portions of f&v a day prevents cancer, anyone? How about "food pyramids", which at their peak were different in different countries. Ours in Australia, which was taught as gospel when I was at school, differed from the WHO one by having more dairy products, thanks to hefty lobbying by the industry.
One of the reasons humans are so successful is that they do quite well on a vast range of different diets, right across the world. The long-lived Japanese eat heaps of salt, and not much fat. Long lived Northern Europeans eat lots of fat and salt in their traditional diets. It is quite possible to live a long and healthy life without eating meat.
But, as we have seen, some people are passionately convinced that they have found the Holy Grail when it comes to the perfect diet.
IMO, people should eat what works for them, and makes life more pleasurable. When I was at uni, I shared a house for a while with a chap who ate nothing but tuna and mayonnaise sandwiches, peanut butter sandwiches, and yoghurt, for weeks on end. Not only was he just fine (never got sick or anything), but he is still with us many decades later, although his diet diversified a bit subsequently.
Relax, and enjoy good food and good booze - life's too short to suffer because of health nannies!
My experience mirrors Shub's. You need to know I've always been rounder than average and have been fighting body fat since 1984 when I was 17 and 6'1" as now and thanks to a balanced calorie control Mediterranean diet went from 101 to 85kg in around 3 months.
I reached bottom at 79 less than a year later, after a school trip to Paris. Since then I've been all over the place, hitting 117kg at the age of 30, only to go on a low starch low fat diet reaching 91kg three months later
I've been experimenting with my body a lot and decided the current low carb on my own, without reading any book or considering any fad. These are some of the ideas behind my choice:
1. My dogs are sighthounds and always hungry. They don't accumulate fat. It's genetic.
2. All my family has always followed the Mediterranean diet of Southern Italy. One grandpa, one of his sisters, one of his sons and one of his daughters (my mother) have fought fat all their lives. Nobody else in the family. Mediterranean dieting isn't THE answer
3. Some foods are called staples. They fill you up. Many people survive on them and little else. In our societies staple foods are still there but also high quantities of meat and sugary stuff. So there's no need to fill one up with staples.
4. Many fatties are poor. This makes no sense from a caloric point of view
5. I need a simple and practical diet, not depending on an army of cooks. I also need be fully active at any time of day or night, as the family including a son two dogs and a cat.
finally I know dieting to lose isn't dieting for life. I'll continue my experiments to figure out how to keep my weight in check. It's only going to be more delicate as I grow older.
Skipping statins with high serum cholesterol doesn't make a lot of sense to me. (Muscle damage is a rare, but serious side effect in humans. It develops in animals when statins are over-dosed. Since drug metabolism varies between individuals, the standard dose may cause muscle damage in <1% of people.)
Lancet. 2005 Oct 8;366(9493):1267-78. Epub 2005 Sep 27.
Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R; Cholesterol Treatment Trialists' (CTT) Collaborators.
Erratum in
Lancet. 2008 Jun 21;371(9630):2084.
Lancet. 2005 Oct 15-21;366(9494):1358.
Abstract
BACKGROUND:
Results of previous randomised trials have shown that interventions that lower LDL cholesterol concentrations can significantly reduce the incidence of coronary heart disease (CHD) and other major vascular events in a wide range of individuals. But each separate trial has limited power to assess particular outcomes or particular categories of participant.
METHODS:
A prospective meta-analysis of data from 90,056 individuals in 14 randomised trials of statins was done. Weighted estimates were obtained of effects on different clinical outcomes per 1.0 mmol/L reduction in LDL cholesterol.
FINDINGS:
During a mean of 5 years, there were 8186 deaths, 14,348 individuals had major vascular events, and 5103 developed cancer. Mean LDL cholesterol differences at 1 year ranged from 0.35 mmol/L to 1.77 mmol/L (mean 1.09) in these trials. There was a 12% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol (rate ratio [RR] 0.88, 95% CI 0.84-0.91; p<0.0001). This reflected a 19% reduction in coronary mortality (0.81, 0.76-0.85; p<0.0001), and non-significant reductions in non-coronary vascular mortality (0.93, 0.83-1.03; p=0.2) and non-vascular mortality (0.95, 0.90-1.01; p=0.1). There were corresponding reductions in myocardial infarction or coronary death (0.77, 0.74-0.80; p<0.0001), in the need for coronary revascularisation (0.76, 0.73-0.80; p<0.0001), in fatal or non-fatal stroke (0.83, 0.78-0.88; p<0.0001), and, combining these, of 21% in any such major vascular event (0.79, 0.77-0.81; p<0.0001). The proportional reduction in major vascular events differed significantly (p<0.0001) according to the absolute reduction in LDL cholesterol achieved, but not otherwise. These benefits were significant within the first year, but were greater in subsequent years. Taking all years together, the overall reduction of about one fifth per mmol/L LDL cholesterol reduction translated into 48 (95% CI 39-57) fewer participants having major vascular events per 1000 among those with pre-existing CHD at baseline, compared with 25 (19-31) per 1000 among participants with no such history. There was no evidence that statins increased the incidence of cancer overall (1.00, 0.95-1.06; p=0.9) or at any particular site.
INTERPRETATION:
Statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one fifth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics. The absolute benefit relates chiefly to an individual's absolute risk of such events and to the absolute reduction in LDL cholesterol achieved. These findings reinforce the need to consider prolonged statin treatment with substantial LDL cholesterol reductions in all patients at high risk of any type of major vascular event.
Rubbish, Frank. The whole statin thing has mainly resulted in the most long-lived people on the planet, who happen to be able to afford statins, to be permanently medicated.
A couple of weeks ago I went to lunch with a healthy, relatively wealthy and privileged, group of friends aged over 55. The topic came up. To my astonishment, the only one of them who was not under permanent medication was me. And, almost all of them were taking statins or other things "just in case."
I'm not a fan of conspiracy theories, by why are millions of rich Westerners taking things like statins "just in case"?
For the record, the only pharmaceuticals that cross my lips are aspirin and codeine mixes (for hangovers) and ibuprofen now and then (for arthritis). But at my lunch table, I was the only person who wasn't on some sort of prescribed medication. And I feel and am just fine.
Mind you, the fact that I haven't been to the doctor in years probably helps.
Frank, the ACC/AHA in the US has abandoned LDL measurement in the diagnosis and monitoring of atherosclerotic vascular risk. Statins are prescribed solely on patients' meeting epidemiologic, rather than clinical criteria - if you are a certain age, race with certain family history etc, you get statins. To me, this signals the original cholesterol hypothesis that statins reduce blood levels of cholesterol and thereby mediate the effect is likely wrong, or incomplete. It also signals a problem with the supposed approach of identifying a risk, treating it and expecting benefit. Patients might as well self-prescribe, or go to practitioners of voodoo or alternative medicine (say like Reiki) and get statins. To date, the AHA starts its support of the cholesterol theory by putting the case of individuals with familial hypercholesterolemia first.
Johanna, cardiovascular risk in women normalizes to male levels slowly in the post-menopausal period. If I remember correctly, they attain male equivalent levels by, say, 60-65 years of age.
shub, all the more reason why people shouldn't routinely subscribe to this week's fashions about heart disease. Women have outlived men by a significant margin for as long as statistics have been collected. And this transcends all medical mantras, diet fads and indeed, acknowledged medical advances.
Nearly a decade ago I was started on the road to ruin with a blood pressure medication and a statin. Guess what? The BP med raises your cholesterol. Together, they rot your muscle tone. The statins give you hellish muscle cramps. If you took the meds for a decade, then some of the side effects are irreversible. You want erectile dysfunction? You want alleged type II diabetes? These are side effects too. My experience of the diabetic med is that it made me feel genuinely suicidal.
Over the past year, I've rolled back the meds and now I'm not taking any. Frankly, I don't care if I die - with the worst muscle spasms I begged for release.If it happens, then it's the National Death Service (envy of the world) for me.
If you take the common BP meds they now say you can't take the effective pain relief.
If I knew what these meds would do, I would never have taken a single one.
And what for? The elevated 'risk' of cardiac problems with high blood pressure is 0.2% per annum - and that includes people having treatment for it!
In the early 1990s, the FDA came up with the concept of the food pyramids
the food pyramid is not published by the FDA but by the USDA (United States Department of Agriculture). http://fnic.nal.usda.gov/dietary-guidance/myplate-and-historical-food-pyramid-resources/past-food-pyramid-materials
If people were more careful checking where data comes from, they would not mistake the purpose of their publication. The food pyramid was not published for the "health" of people, but for promoting the products the USDA is in charge of; i.e. agricultural products, especially the ones generating the most profit: cereals, sugars, seed oils.