Why Your Doctor Is Wrong About Statins and Fat

Why Your Doctor Is Wrong About Statins and Fat by Dr Paul Mason | #PHCvcon2021

Why Your Doctor Is Wrong About Statins and Fat

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Video Transcript

I’m dr paul mason have you ever wondered why doctors give bad nutritional advice well part of the problem is that by and large doctors get next to nothing in terms of nutrition training fortunately many doctors recognize this blind spot and set out to educate themselves unfortunately many of those who do educate themselves feel pressured to avoid sharing their newly gained knowledge with patients as it is often in conflict with dietary guidelines and i’d rather not have to worry about any potential blowback for giving unconventional advice and so patients keep on getting the same old outdated nutritional advice and the same pressures that mean doctors often don’t provide their patients with the best nutritional advice that they could also influences their prescribing habits where doctors may feel pressured to prescribe medications in situations they wouldn’t if it were say to a family member never mind the creed first do no harm last year i received this email from a doctor and she was feeling pressured to prescribe statins to all of her diabetic patients her medical group was reviewing her prescribing habits to make sure that each and every one of her diabetic patients was on a statin as per the guidelines but she wasn’t sure if prescribing statins to diabetics was necessarily a good idea so she went looking for the evidence herself actual scientific papers that would answer the question of whether every diabetic patient should be taking a cholesterol lowering statin drug and she came across this an expert review paper which strongly promoted statin prescribing for diabetic patients and there was no two ways about it statins were unambiguously recommended basically it was claimed that taking statins would help diabetic patients live longer and six references were cited in support of a statement which indicated statin using diabetics would reduce the chance of dying so i went and looked up each of these six references to see if they did indeed support the claim that statins reduced the chance of dying in diabetic patients the first reference fell down at the first hurdle it didn’t actually provide any data on mortality and while the second study did report on mortality the findings didn’t reach statistical significance basically the finding could be explained by random chance and this was also true of the next two studies neither of which had findings likely to be due to anything other than chance and like the first two studies the last two studies referenced here didn’t actually measure mortality as a function of statin use basically the claim that statin use in diabetics can reduce mortality is completely and utterly unsubstantiated by these references which should beg the question how on earth did this expert review paper ever get through the peer review process a process which should ensure published articles such as this can be trusted to tell the truth and understand that statin drugs may cause particular issues for blood sugar control not only did the woman’s health initiative study find that statin use was associated with a 48 increased risk of diabetes but statins also worsen sugar control in those already diagnosed indeed even the official prescribing information available on this drug manufacturer’s website wants that statins not only increased blood glucose levels but they also increased the likelihood of being diagnosed as a diabetic in the first place and so the expert review paper recommending statins to diabetic patients illustrates a major problem in medicine today reliance on experts these esteemed experts are often ignorant of the evidence themselves and can perpetuate long-standing myths and falsehoods this is called eminence-based medicine basically those in positions of authority at venerable institutions exert an undue degree of influence over general opinion often in direct contradiction to the actual science eminence-based medicine it should be said is the direct enemy of evidence-based medicine which is based on critical appraisal of the best available science now coming back to the email this doctor was clearly trying to do the right thing she knew enough to not necessarily trust expert opinion or guidelines many doctors however aren’t aware that they’ve been misled and fed falsehoods during their training the fact is even in 2021 most doctors still believe hook line and sinker the nutritional falsehoods that they’ve been taught in medical school i saw this myself when i gave a group of junior doctors a short test on nutrition and they were outscored by my receptionist and if this reflects the nutritional knowledge level of the average doctor what hope is there for the general public they might for instance be guided in their food choices by the food star system not understanding that it is an absolute joke which is being gained by industry take this cereal which contains 17 sugar and still scored five stars while this naturally cured salmon contains only salmon and salt and that scores just 1.5 stars when this is the kind of messaging we have is it any wonder people make bad food choices and just as the public can be misled by the food star system doctors can be deceived by a lack of openness and transparency in the reporting of data you may be familiar with the woman’s health initiative study published in 2006 this massive study of over 48 000 females cost 700 million us dollars it was designed to definitively determine whether or not low-fat diets benefited health well that’s not exactly true you see the investigators already held the view that low-fat diets would be beneficial and all they really wanted to do was for this study to prove the hunch to do this participants were randomised to either a low-fat or a regular diet and followed for about eight years and given the size and prominence of this study its results were published with great fanfare the lead investigator going on record is saying the findings demonstrate the need indeed the benefits of dietary reductions in fat even greater than 10 percent except the results showed nothing of the sort not that you could figure this out if you read the results table or the conclusion in the published study now to get to the truth you had to go to page 661 of the journal in which it was published and there an obscure text was the only statistically significant finding of the whole study the only finding of this whole study not likely to be due to chance alone the finding was that those randomised to the low-fat diet did worse those with a history of prior heart disease who were randomized to the low-fat group suffered a 26 higher chance of complications like repeat heart attacks how was this finding from a publicly funded 700 million dollar study kept hidden from the public view how were the researchers able to conclude that this study didn’t just support low-fat diets but it supported low-fat diets even more extreme than those that were studied the way the results were presented was flat-out deceptive leading doctors and scientists and ultimately the public the world over to believe this study provided evidence for low-fat diets when in fact it provided the opposite you may have also heard of the sydney diet heart study a good quality randomised control trial examining in men who’d had heart attacks the effect of replacing removing saturated fat from the diet and replacing it with polyunsaturated fat and the result on whether or not this diet actually reduced the risk of death was actually destined to never be published it was only a stroke of luck that a researcher uncovered the original study data in a basement was able to decode it and publish it some 40 years after the study concluded and so in 2013 the results of the sydney diet heart study were finally published in the british medical journal the conclusion reducing saturated fat in the diet and increasing polyunsaturated fat in the diet increased the risk of death in the study population by 62 percent this is probably one of the most important bits of research you’ve never heard about and truth be told one you almost didn’t find out about now of course evidence like this which undermines the orthodox view on dietary fat is not going to go unchallenged and indeed it faced a barrage of criticism most of it deceptive and relevant the one argument that most often gets repeated is that the 62 increased risk of death was due to an increase in trans fat consumption specifically it’s claimed that the margarine consumed in the intervention group was high in trans fats and for all intents and purposes this argument is the only justification that saturated fat-fearing zealots have for ignoring the harms of polyunsaturated seed oils as demonstrated by this study this argument however is flawed it comes down to the difference between hard and soft margarines hard margarines did indeed back then contain trans fats however the margarine used in this study was miracle brand a soft margarine and clearly advertised as such and soft margarines contained very little if any trans fats and the consumption of biscuits cakes pastries and puddings all of which were often made with trans fats containing hard margarine was expressly discouraged in the intervention group furthermore safflower oil which also contains little if any trans fat was used in the intervention group further displacing other sources of trans fats the upshot of all of this is that the trans fat intake of the intervention group almost certainly reduced which leaves us in with the uncomfortable truth that the increase in polyunsaturated oils in the diet as recommended by current dietary guidelines increased the chance of dying by 62 all shown by a good quality long-term randomized control trial and the sydney diet heart study is not the only randomized control trial showing the harms of replacing saturated fat with polyunsaturated oils the minnesota coronary survey also completed in 1973 was a gold standard double-blinded randomized controlled trial on more than 9 000 men and women in which a high saturated fat diet was compared with a high polyunsaturated fat diet and again like the sydney diet heart study the results were almost lost to history that is until in a striking case of deja vu the original study data was recovered and finally published in 2016 and again the results mirrored those of the sydney diet heart study reducing saturated fats and increasing dietary polyunsaturated fats increased the risk of dying and there’s a footnote here before his death the lead author was asked about the delay in publishing the study findings to which he replied it was because the study findings were disappointing clearly this is not how science should work and yet it does we’ve just seen egregious examples of where the truth regarding the harms of polyunsaturated oil consumption was almost lost to history simply because of the bias of the investigators of course we still face a problem that even when research is clearly and accurately portrayed that it is either ignored or dismissed without foundation and this paper suffers from both despite being published in one of the world’s most prestigious medical journals few doctors i speak to outside of the low-carb sphere have even heard of it and one reason i suspect it hasn’t been widely shared and discussed is that its findings effectively demolish the argument that we should avoid saturated fat because it can increase our ldl levels it found in fact that those with the highest ldl levels lived the longest much easier to pretend this study just doesn’t exist the thing is this is a systematic review which included every prospective cohort study available to answer the question of what happens to those with high levels of ldl cholesterol it didn’t involve any cherry picking of the data all suitable studies were included in fact this ended up being 19 prospective cohort studies with over 68 000 participants and collectively the overwhelming finding was that individuals with the highest ldl levels tend to live longer in fact 16 of the 19 studies found this relationship the higher your ldl level the lower your chance of dying let’s now take a closer look at the data from the individual studies different studies are represented by rows with the four columns representing ldl levels basically each column represents a grouping of 25 of the study population based on ldl levels the left hand column is those with the lowest ldl levels and the right hand most column represents those with the highest ldl levels and the numbers represent relative risk of dying with numbers less than one indicating a reduced chance of death and if you compare chance of death between those in the lowest ldl column and those in the highest ldl column you’ll note that the higher ldl levels are clearly associated with a reduced chance of dying this study for instance found those with the highest cholesterol levels were 34 percent less likely to die over the duration of the study when compared to those with the lowest ldl levels this one for the same comparison found a 47 reduced chance of death again in favor of high ldl levels and as you look through the studies you’ll note this is a consistent finding but still some people reject this finding claiming that reverse causality might be at play the concept of reverse causality is basically that illness lowers ldl levels and so that those with the lowest ldl levels might simply represent those who are already ill indeed a drop in ldl level in the last two years of life is well known in the scientific literature but this argument fails on three levels first of all the average duration of observation in each of these studies was significantly longer than two years and still those with the highest ldl levels lived the longest secondly even when study subjects with terminal disease heart disease or diabetes were excluded there was no change in results not even a weakening of the findings this study found about a 50 reduction in the chance of death in the highest ldl group despite making these exclusions and finally even if we exclude the 25 with the lowest cholesterol levels supposedly those with the chronic illnesses and compare those in the second quartile of ldl against those with the highest ldl levels we still see superior outcomes in those with the highest ldl levels the fact is the findings of this systematic review are robust and dismissing or ignoring these findings is scientifically dishonest of course if one accepts the premise that ldl may not be that bad for you it brings into question whether or not statin drugs widely promoted for their ability to lower ldl levels are as helpful as claimed most people take statin drugs to prevent dying but that’s not the right way to think about it because everyone is still going to die rather the question to answer is how much longer will i live by if i take this drug and that’s the question that this paper set out to answer it identified all the available studies so again no cherry picking that provided suitable data in the end data from 11 studies involving over 90 000 participants was available and it was shown that subjects who had a previous heart attack gained a median of 4.1 days of life and those without a history of heart disease they gained 3.2 days of life and this was after taking statin drugs for years also understand there have been many more studies on statins published which were not included in this review for the simple reason that drug companies have not made the participant level data available for independent analysis to this very day independent scrutiny of much of the research performed over the years remains blocked one might well ask what would happen to the three or four days life extension if all the data was available and this is a meta-analysis of randomised control statin trials published in february of this year it concluded that for those between the ages of 50 and 75 there is no mortality benefit in taking statins interestingly it did note that only one of the eight trials reviewed showed some mortality benefit known as the jupiter trial this is the one study that is continually recycled by those promoting statins seemingly content to ignore the findings of the other seven studies another common example of what i consider to be an egregious dismissal of scientific evidence is with respect to high fat diets and weight loss between 2003 and 2018 there were 62 published randomised controlled trials comparing weight loss on high fat and low fat diets and of these 62 studies 31 exactly half had statistically significant results while the other 31 had results which may have been due to chance and so here i’ve graphed the results of the 31 studies with statistically significant results leaving out the studies whose findings could have been due to chance the green bars represent the amount of weight loss on a high fat diet and the adjacent red bar the amount of weight lost in the low fat group and if you look at each pair of results you’ll see that those on higher fat diets lost more weight in all of them all of them not one single study found in favor of low-fat diets for weight loss and despite this overwhelming evidence many doctors still promote low-fat diets for weight loss this is a copy of the handout one of my patients received from another doctor recommending a low-fat diet when doctors ignore the science like this it’s no wonder we have an obesity epidemic and some doctors can’t even bring themselves to question their beliefs even when they see patients heal themselves before them i had a 71 year old male patient who amongst other things had reversed diabetes fixed his blood pressure stopped five medications and put his inflammatory bowel disease into remission all with dietary change you’d think his original diabetes doctor an endocrinologist would be happy well in this letter to me his doctor acknowledged that the resolution of his diabetes was likely due to his new low carbohydrate diet but then he proceeded to recommend he resumed the exact type of high carbohydrate diet the patient was on when he developed his multiple medical issues in the first place despite the patient clearly telling his doctor that he had already tried that diet previously and for good measure the doctor recommended this diabetic patient take a statin despite already having taken one with side effects but there is now some light at the end of the tunnel for example the american college of cardiology once a bastion of anti-saturated fat dogma has now shifted its opinion in this recent review paper it is acknowledged that the weight of evidence does not support restricting saturated fat indeed it is explicitly recommended that dairy meat and eggs be freely consumed and to understand the significance of this shift you need to realize that three of the authors of this article were on the committee which produced the 2005 dietary guidelines for americans and that includes the chair of the committee all we need now is for our guidelines in medical education to catch up or at the very least for doctors to begin to independently appraise the literature for themselves now for health professionals who do understand the science but are afraid of recommending against the dietary guidelines know one thing on page two of the australian guidelines it is explicitly stated that the guidelines only apply to those who are healthy not to those with medical conditions which require specialized dietary advice and i’m yet to meet a medical condition that could not be impacted by dietary advice in effect if you’re providing nutritional advice to manage diabetes or obesity the dietary guidelines do not apply so if you’re confused by your doctor’s advice understand that doctors don’t have a monopoly on knowledge indeed my observation is that doctors are at least as likely as everybody else to demonstrate cognitive dissonance when faced with evidence that challenges their beliefs don’t blindly trust so-called experts we should no longer confuse eminence for evidence only evidence should guide the practice of medicine thank you

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