Cholesterol and Statin
Muhammad Usman Naeem, Abdul Ghani MD
Cholesterol and Food
- Food only contributes 20% to 30% of LDL cholesterol. Fat reduction in food reduces LDL cholesterol levels by 20- 30% or less.
- Food like beans reduces cholesterol absorption from the gut.
- Fruits and vegetables also reduce the fat by escort effect and by reducing inflammation.
With statins, doctors have learned two other factors:
- Plaques.
- Inflammation.
Inflammation hurts a patient on both ends. It helps LDL to start plaque and causes platelets to become stickier. With sticky platelets, a heart attack is serious (more heart damage) and fast (patients, e.g. diabetics and smokers, die at the scene or do not make it to the ER.) Reduction of inflammation with fruits, plants, exercise, omega 3 fat (fish, omega 3 fatty acid capsules), and olive oil helps on both ends; it prevents the formation of plaques and reduces stickiness of platelets.
Competition exists between the liver and the gut. Cholesterol is produced in the liver with 20%- 30% coming from food. Cholesterol is also needed in the body to produce steroids, vitamin D, bile salts, and sex hormones (testosterone and estrogen). This makes the body “want” some cholesterol. If a person eats a lot of fatty food, the liver makes less cholesterol. If a person eats less fatty food, the liver makes more cholesterol. This is the reason low-fat diet reduces cholesterol by only 10%-20%, which does not look too impressive. The physician and the patient both lose “faith” in a low-fat diet.
When a patient takes a statin, the liver makes less cholesterol, but the gut absorbs more cholesterol from food. The net effect of a statin and healthy food is 30-35% plus 10-15% = 50% reduction in blood cholesterol. Unsweetened oats are tagged with bile salts (produced in the liver using cholesterol) and escort them down and out. To make Up for the “loss of bile salts” the liver has to pull more cholesterol from the blood and make extra bile salt, causing the reduction in blood cholesterol.
The Statin Story: Strength and Limitations
Before statin, people thought that heart attacks occurred when an artery was completely blocked by deposits of fat (cholesterol) inside the lumen, and in the 90s statins started to prevent a heart attack. When angiograms were done before and after a heart attack, there was no change in the size of the lumen. Attention shifted from the artery to the wall of an artery. Turns out that there were plaques (packages of cells, fat, and inflammatory chemicals) on the wall. Plaques were the ones causing heart attacks.The higher the cholesterol, the more inflammation in the body. The more the fat in plaque, the more fatty plaques. When plaque ruptures, tissue factors (glue-like material) come out. They attract platelets (cells that stop bleeding) and fibrinogen. These make a gob at the site of ruptured plaque, and that stops blood flow. This causes the death of the heart muscle downstream.
When cholesterol in the blood is reduced, there is less fat in plaque. Then the rupture of plaque does not attract too many platelets or fibrinogen. There is no stoppage of blood flow. No heart attack. All the debris (from ruptured plaques) e.g. cells, Fat, and chemicals) start to line up to deposit on the wall of the artery. This starts the process of atherosclerosis (hardening of the arteries). People start building plaque at the age of 20.
With unhealthy food and the lack of exercise, heart disease has moved up from 60-70 years (old age) to 50 years old (middle age).
What can 40-year-olds do? They have plaque buildup at 20 years, and they are 10 years away
from having heart disease. It takes a statin three weeks to bring cholesterol down in the blood,
but it takes 12-18 months to leach out fat from the plaques. Cholesterol should be kept down in
the blood throughout life.
In the 40s, a person suddenly decides not to take “medicine” and some herbs (the natural stuff). This is not wise. When given to a lot of people, statins start to save lives in as early as 30 days. More people die without statins than with statins.
In the 40s, a person suddenly decides not to take “medicine” and some herbs (the natural stuff). This is not wise. When given to a lot of people, statins start to save lives in as early as 30 days. More people die without statins than with statins.
Statins, Food, and Liver
The liver makes cholesterol from scratch. It needs to produce sex hormones, steroids, and Vitamin D, and bile salts (used in bile to help digest foods). The body gets 15 to 20% of its cholesterol from the gut. There are two sources of cholesterol. One is the liver, and the other is the gut. Because of the necessity of producing sex hormones and steroids, the body likes to have a certain amount of cholesterol.When we take statins, we have lower cholesterol production in the liver. The gut will absorb more cholesterol from food. The net result is a 30% reduction in cholesterol. If we reduce fat in a diet, the net result is a 10-15% reduction in cholesterol. With a statin and a low-fat diet, we can reduce cholesterol by about 50%.
But a diet involves much more than cholesterol.
1)Fruits and vegetables reduce oxidation and inflammation.
Without oxidation and inflammation, plaque cannot be built.
2) Oats reduce cholesterol by different mechanisms, attaching themselves with bile salts and escorting them down and out, thus reducing cholesterol because bile salts are made of cholesterol.
Without oxidation and inflammation, plaque cannot be built.
2) Oats reduce cholesterol by different mechanisms, attaching themselves with bile salts and escorting them down and out, thus reducing cholesterol because bile salts are made of cholesterol.
Confusion about Statins
Statin mostly acts on LDL and reduces it by 25%. Half of the patients with heart disease have the same level of cholesterol as people without heart disease. The difference is inflammation. People without an LDL of 60 and inflammation can still develop heart disease.When people develop heart disease on a statin, they lose faith in those statins. What is needed with a statin is healthy food and walking. That reduces inflammation and TG and increases HDI.
With $4.00 a month and a 25% reduction in heart disease, statins are the best drugs on the planet. Heart disease is a faceless killer; plaque is invisible. Cholesterol becomes the face of heart disease, which could be misleading. Low LDL cholesterol is good, but it is not guaranteed against heart disease unless HDL is high, and TG are down to 120 mg.
Nature of HDL
HDL not only is an antioxidant, but it also cleans the arteries. A person lives a healthy life, eats healthy food (no inflammation), and exercises by walking to prevent and stabilize many diseases like HTN, DM, and cancer. He also prevents heart disease. When a person lives an unhealthy life, he/she develops not only HTN, DM, and cancer but also heart disease.Because of the double role of HDI, heart disease is the #1 killer.
Arteriosclerosis is a medical disease (preventable by a healthy lifestyle, statin, and ASA). By the time it is diagnosed, it is a surgical disease requiring a stent and/or a bypass.
Most of these metabolic diseases (HTN, DM, heart disease, and 50% of the cancers) are not caused by nature but by folks in the U.S.
When Patients Refuse to take Statins
- 85% of people can tolerate a stain. 15% have muscle pain.
- Chronic pain is becoming common. Pain could be attributed to a statin. CPK level can be done
if there is actual “muscle damage” caused by a statin. - If a patient refuses to take statin, he/she must do lots of exercises to raise HDL cholesterol and
eat healthy foods. - Get an EBCT (electron beam CT) at the ages of 40, 45, and 50. It costs $200.00 and gives a
calcium score (a measure of plaque load). The higher the score, the more plaques there is. EBCT
will convince the patient about statin and healthy food.
“Patterns” of Cholesterol
Cholesterol (at least 20%-30%) comes from food; 60%-70% of cholesterol comes from the liver. The liver “part” does not change unless treated with medicines. If a person has high cholesterol at age 50, he had high cholesterol in his 20s which correlates with plaque formation. (Plaque starts building up at age 20). Since heart disease has moved down from age 70 to 50, even in the late 40s, high cholesterol should be treated early.Citation list
- ENDO, A. (2010). A historical perspective on the discovery of Statins. Proceedings of the Japan Academy, Series B, 86(5), 484–493. https://doi.org/10.2183/pjab.86.484
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