WHY YOUR DOCTOR THINKS CHOLESTEROL IS BAD

WHY YOUR DOCTOR THINKS CHOLESTEROL IS BAD FOR YOU.

The deception of Big Farma

In this in-depth study you will find the translation of this video by Dr. Paul Mason an Australian physician who uses evidence-based medicine with his patients. Here the his site. As always, the regular texts are Dr. Mason's words while the italicized ones are my observations.

As a reminder, you can find the other Live Better insights in this page

Good morning,
many people believe that their doctors give them fallacious information about nutrition and medications. But is it true that they are given unreliable? Yes, but not deliberately.

It may surprise you, but a great many physicians find it difficult to navigate the tangle of information when it comes to discerning between fact and fiction in the scientific literature.

Last year I received an email from a colleague: the medical association to which she belongs was reviewing her prescriptions to make sure she had prescribed statins to all her diabetic patients. Basically, she was being pressured to prescribe statins to all her diabetic patients despite the fact that she thought many would not benefit. So she went looking for scientific evidence and found this study (1) that recommended prescribing statins to diabetics claiming that statins would help them live longer.

She asked if I could help her understand the results of the study.

The study, cited six studies to support its conclusion: statins extend the lives of diabetics. I went to look them up and read them all.

The first point to clarify is that when a scientific study makes claims about mortality it must look at mortality. It would seem obvious, yet three of the six studies cited did not analyze mortality. Instead, the other three studies had analyzed mortality, but did not obtain statistically significant results (i.e., the results could be caused by pure chance.

These kinds of results cannot justify the use of a drug should, especially when the drug may increase the likelihood of developing diabetes, as discovered by the Woman's Health Initiative study (2): it was found that the risk of developing diabetes increases by 71% in those taking statins.

The scientific evidence cited in support of the recommendation to prescribe statins to diabetic patients was anything but evidence, yet this publication had some influence and was in fact cited as many as 69 times in the scientific literature.

Elena’s tip:
The number of citations is now interpreted as one of the measures of the impact (importance) of a scientific publication.

Now I want to tell you about something very interesting: in 2014 an article was published in Nature that analyzed how many citations scientific publications have on average:
the published studies were 58 million of these
25,332,701 has ZERO citations (the 44% of 58 million)
18,280,002 has 1 to 9 citations (31%)
13,104,875 has 10 to 99 citations (23%)
Practically 75% of the published studies have fewer than 9 citations.

But what is a quote?
Study A is “cited” when another study B talks about study A and its results. In theory, the more interesting the results of the study are, the more it should be cited.

So what does it mean when a study has few citations?

A) It could be a study that talks about extremely specific topics in a field where there are few researchers, such as mathematics. Therefore, in this case, the studies do not have many opportunities to be cited

B) The second case which is also the most frequent: what emerged from the study is of no interest to anyone. So is the study useless? Perhaps, however, maybe it was useful to realize that Hypothesis A was not the correct one and then proceed to investigate Hypothesis B, C, etc. which could then lead to a great discovery! Remember what Thomas Edison said when asked how he felt about having failed 2,000 times mind trying to invent the light bulb “I did not fail 2,000 times, I simply found 1,999 ways how the light bulb should not be made.”

Now that you know that the 75% of publications has less than 9 citations, you understand Dr. Mason's amazement that the study he is talking about had as many as 69 citations!

This episode shows us the existence of a very big problem: medicine based “on eminence” that is, relying on expert opinion although it is often just perpetuating long-standing myths and falsehoods. Basically, those in preeminent positions at important institutions exert great influence on general opinion based on medical eminence. It must be said that this is the main enemy of evidence-based medicine that is based on critical evaluation of the best available scientific research.

But back to the email: this doctor was clearly trying to do the right thing and had enough knowledge not to necessarily trust expert opinion, but most doctors do not know how to do that and are not aware that they have been sidetracked and infused with falsehoods during their training.

Even in 2021, most doctors still bite on the nutrition falsehoods they have been taught. I witnessed this myself when I gave a short nutrition test to a group of young doctors and they scored lower than my receptionist.

If this reflects the average doctors“ expertise on nutrition, what hope is there for patients? Surely they are being influenced by the Food Star System (Australian nutritional rating system of foods based on assigning stars) without understanding that it is a lie by the food industry: ”buy this cereal with 5 stars (despite containing 17% of added sugars), while this smoked salmon has only 1.5 stars."

It is therefore not surprising that people make poor food choices. And just as the public can be fooled by the Food Star System, doctors can be fooled by the lack of clarity and transparency in scientific publications.

I have already mentioned the Women's Health Initiative Study published in 2006 (3) a massive study of more than 48,000 women, costing $700 million, designed to determine once and for all whether low-fat diets were beneficial for health. Well, unfortunately, the published results are not entirely true. You see, those who conducted the study were already convinced that low-fat diets were beneficial and simply wanted to prove their belief.

Two groups were taken and assigned to either a low-fat diet or a regular diet and were kept under observation for the next eight years. Given the size and prominence of this study, its results had great resonance: the benefits of reduced fat intake were even greater than the 8/10% found in the study.

Too bad that the results showed absolutely nothing of this kind, but it was impossible to understand this by reading the tables or the conclusions. To get to the truth, one had to proceed all the way to page 661 of the journal where the study had been published, and there, in opaque terms, was reported the only truly significant result of the entire research, most likely the only result that was not related solely to chance: those who had been assigned a low-fat diet had worse outcomes. Those who had a history of heart problems behind them and who had followed the low-fat diet had a 26 % higher likelihood of complications such as heart attacks.

How was it possible to keep this result contained in a study costing $700 million of public money from the public? How were the researchers able to conclude that not only did this study support low-fat diets, but demonstrated the benefit of even more extreme low-fat diets than those that had been the subject of their study? The way the results were presented was blatantly misleading, yet doctors, scientists, and to follow the general public were led to believe that this study provided evidence in favor of low-fat diets.

You may have already heard of the Sydney Diet Heart Study (4) (I had mentioned this in the’this insight On the Le Iene report and the Fat Fiction documentary) an excellent randomized controlled trial that looked at the effects of replacing saturated fats with polyunsaturated fats in men who had had heart attacks, trying to determine whether this diet actually reduced the risk of death.

This study was destined never to be published, and it was actually only by a stroke of luck that a scholar found the data from the original study in the basement and was able to decode and publish it some 40 years after the study was concluded.

So in 2013 the results of the Sydney Diet Heart Study were finally published in the British Medical Journal: reducing saturated fat in the dietary diet and increasing polyunsaturated fat increased the risk of death by 62%. This is probably one of the most relevant studies and you have probably never heard of it.

Of course, scientific evidence such as this that disrupts the orthodox view on the danger of saturated fats will not be accepted without being questioned, and in fact it has been subjected to numerous criticisms, most of them misleading and irrelevant.

The argument that is used most is that the 62% increase in the risk of death was driven by increased consumption of trans fatty acids, and specifically it was stated that the margarine consumed in the group tested had a high trans fatty acid content.

This argument is the only justification these saturated fat-frightened fanatics have for being able to ignore the harm caused by polyunsaturated seed oils. This, however, is a flawed argument because it does not take into account the difference between solid and soft margarines.

At that time, indeed, solid margarine contained trans fatty acids, but the margarine used in the study was Miracle, a soft margarine containing very few, if any, trans fatty acids. And consumption of products made with solid margarine containing trans fatty acids was expressly discouraged in the group that followed the vegetable fat diet.

In addition, this group used safflower oil, which contains little or no trans fatty acids. So the intake of trans fatty acids was minimal. The unpalatable truth is that increasing polyunsaturated fats in the diet, as today's dietary guidelines recommend, increased the odds of 62% death.

The Sydney Diet Heart Study is not the only randomized control trial exposing the harm caused by replacing saturated fats with polyunsaturated oils.

The Minnesota Coronary Survey also completed in 1973 (5), is a randomized double-blind study of more than 9 000 men and women in which a diet high in saturated fat was compared with a diet high in polyunsaturated fat. Again, as in the Sydney Diet Heart Study, the results were almost lost to history until in a surprising case of deja vu the original study data were found in a basement and published in 2016 (6). Again, the results mirrored those of the Sydney Diet Heart Study: reducing saturated fat and increasing polyunsaturated fat in the diet increased the risk of death. There is a note here; before his death, the principal investigator was asked why they did not publish the results of the study and he replied “because the results were disappointing. ”It is self-evident that science should not work this way and yet it does. We have just seen two striking examples of situations where the results regarding polyunsaturated oils were almost hidden simply because the
researchers did not like the results.

Of course, we also face the opposite problem: even when research is carried out clearly and accurately it is either ignored or dismissed without foundation (7). This publication suffered both. Despite being published in one of the most prestigious medical journals in the world (Ed. the British Medical Journal) very few of the physicians I talk to know of its existence. And I suspect that one of the reasons it has not been widely shared and discussed is that its conclusions demolish the hypothesis that we should avoid saturated fats because they might increase our LDL cholesterol levels. In fact, this study found that those who had the highest levels of LDL cholesterol lived longer. Much easier to claim that this study simply does not
exists.

The fact is that this is a systematic review that includes every cohort study available to answer the question: what happens to those with high LDL cholesterol levels? Every single relevant study was included: 19 prospective cohort studies with over 68 000 participants: the overwhelming conclusion was that individuals with the highest levels of LDL cholesterol live longer.

Elena notes a systematic review is a study that considers all published studies on a given topic and analyzes the results. Systematic reviews along with meta-analyses are the most valuable on the level of scientific evidence.

A prospective cohort study, on the other hand, is a study that follows for pungo time a group of fairly similar individuals who nonetheless do different things and who are healthy at the beginning of the study. For example: one can follow a cohort of middle-aged truck drivers who either smoke or do not and test the hypothesis that in 20 years the incidence of lung cancer will be higher in heavy smokers.

In fact, 16 of the 19 studies found this relationship: the higher the LDL cholesterol level the lower the likelihood of death. Let us now take a closer look at the data from the different studies. On each row are the results of the 19 studies while the four columns represent LDL cholesterol levels. Basically, each column represents a grouping of the 25% of the population in the study according to LDL cholesterol levels. The column on the left shows those with the lowest LDL cholesterol levels and the column on the right those with the highest levels.

Numbers represent relative risk of death. Less than 1 indicates a reduced probability of death. If you compare the likelihood of death of those with the lowest LDL cholesterol levels versus those with the highest levels you will notice that the latter are clearly associated with a reduced likelihood of death. For example, this study found that those with the highest levels of LDL cholesterol were less likely to die than those with the lowest levels of 34%. (Ed. how do you arrive at 34%? 1 minus 0.66 equals 0.34) This study found a reduced likelihood of death by 47% in those with the highest level of LDL cholesterol.

If we examine all the studies, we will notice that there is uniformity of results. NdE as we move to the right (i.e., to the groups of people with the highest LDL levels) the smaller the number becomes (meaning lower risk of death).

Yet some people still reject these findings and claim that it could be reverse causality. The concept of reverse causality means that disease decreases LDL cholesterol levels and therefore the individuals with the lowest LDL cholesterol levels are simply those who are already sick. Indeed, a decrease in LDL cholesterol levels in the last two years of life is clearly reported in the scientific literature, (8) but this argument is inconsistent on three different levels:

the mean observation period in each of these studies is significantly longer than two years, and yet those who had the highest levels of LDL cholesterol lived longer.
even when those with terminal illness, heart disease or diabetes were excluded from the study subjects, there was no shift in the results, not even a slight drop in the results. This study found an approximately 50% reduction in the probability of death for those with the highest LDL cholesterol levels despite these exclusions.
even if we exclude the 25% with the lowest LDL cholesterol levels, presumably those with chronic disease, and compare those in the second quartile of LDL cholesterol levels with those with the highest levels, we still notice better results in those with the highest LDL cholesterol levels.

In fact, the reality is that the results of this systematic publication are solid, and to dismiss or ignore these results is scientifically dishonest.

Another widespread example of what I consider to be a blatant rejection of scientific evidence concerns high-fat diets and weight loss. Between 2003 and 2018, 62 randomized controlled trials were published comparing the weight loss of individuals on high- or low-fat diets. Of these 62 studies, 31 had statistically significant results while the other 31 had results that could be ascribed to chance. Here I have reproduced the results of the 31 studies with statistically significant results: the green bars represent weight lost on a high-fat diet while the red bars represent weight lost on a low-fat diet.

If you look at each pair of results, you will see that those on the high-fat diet lost more weight in all studies. Not a single study has results in favor of the low-fat diet. Despite this overwhelming evidence, many doctors still promote low-fat diets for weight loss. When doctors ignore science in this way, there is no surprise that we have an obesity epidemic. Some physicians cannot even bring themselves to question their beliefs when they see patients healing before their own eyes. Take, for example, this 71-year-old patient of mine who, thanks to a change in diet, was able to

putting diabetes into remission
fix his blood pressure
stop taking five medications
Achieve remission of his IBD (chronic inflammatory bowel disease)

You would think that his endocrinologist who originally treated him for diabetes would be happy--well, in this letter to me, his doctor acknowledges that the remission of his diabetes is probably related to his new low-carb diet. But he goes on to recommend that he return to the exact same type of diet he was on when he developed all these medical problems, despite the patient clearly telling him that he had already tried this recommended diet without success. He also recommends that the patient take a statin, despite the fact that he had already experienced side effects with another statin.

But now there is light at the end of the tunnel: for example, the American College of Cardiology, formerly a bastion of dogma and anti-saturated fat recommendations, has now changed its mind: in this recent publication it acknowledges that the evidence is not in favor of reducing saturated fat intake ^[9]. In fact, it explicitly recommends that dairy, meat and eggs be freely consumed!

To understand the magnitude of this shift, you need to understand that three of the authors of this article ^[9] were part of the committee that drafted the 2005 Food Guides for Americans. And among them was the chairman of the committee itself!

All we need now is for guidelines and medical education to update or, at the very least, for physicians to begin to independently evaluate the scientific literature.

Now, for health professionals who understand the science but fear making recommendations that conflict with the nutrition guidelines, you should know something: page two of the Australian Dietary Guidelines explicitly states that the guidelines apply only to those who are in good health and not to those who have a medical condition that requires specialized nutrition counseling. So if you are providing nutritional counseling to manage diabetes or obesity, the guidelines should not apply.

Ed: I wonder if there is the same message in our guidelines as well. If any of you were aware of this information please email me elena@livebetter.eu.

So if you are confused by your doctor's advice, you need to understand that doctors do not have a monopoly on knowledge. In truth, my observation is that doctors are as likely as any other person to demonstrate cognitive dissonance when confronted with evidence that challenges their beliefs. Do not blindly trust so-called experts. Do not keep confusing eminence with scientific evidence. Only evidence should guide medical practice. Thank you

NdE “Cognitive dissonance” is created when two notions/beliefs are at odds with each other. Let's take an example: imagine you are a 60-year-old physician: for 40 years I have been hearing that LDL cholesterol is the cause of cardiovascular disease. A patient of mine sends me the study ^[7] cited by Paul Mason that not only shows that LDL cholesterol is not the cause of cardiovascular disease but even that people with high LDL live longer. This information is contrary to what I have always believed to be true. How is this possible? If it were true it would have been reported on television, right? Ah okay, then surely the study my patient sent me is incorrect. Good thing, I can continue to believe what I have believed so far. Unfortunately, this behavior is VERY human, because sticking to our beliefs is easier, requires less effort. Besides, let's be honest: how many Italian doctors speak English and are therefore able to read a scientific study published in an international journal. If you want you can try: at this link found the pdf of the study on LDL and mortality ^[7]. Print it out and take it to your doctor.

This is why it is so important to be responsible for our own health.

“Very often the great enemy of truth is not the lie - deliberate, planned and dishonest - but the myth - persistent, persuasive and unrealistic. Too often we cling to the clichés of our ancestors, subjecting facts to a prefabricated set of interpretations. We enjoy the comfort of opinion, Avoiding the hassle of having to think.”. John F. Kennedy

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