April 3, 2020
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[Music] this lecture is being brought to you in part by the generous gifts of these sponsors thank you and for inviting me to an encore performance at IHMC we’ll also thank Michelle for handling all the arrangements so well so as you can see from my title this will be controversial and but what’s a challenge now is that there’s so much confusion experts have such different opinions as to what we should eat what we shouldn’t eat and what medication we should take to improve our health I think what’s important is understand why that person has that opinion is that person being paid to generate that opinion so what is my motivation why am I here tonight why am i as a neuroscientist why do I study cardiovascular disease so in a sense I have what I have is a disclosure statement first of all I receive no funding at all no payment for any of the research I’m showing you tonight this really began as a personal crusade of my own I had extremely abnormal cholesterol triglycerides which I’ve gone into in detail and other talks but as you could see here I was in the in the extreme this is my risk for developing a heart attack ten years ago over 15 times likely develop a heart attack compared to someone with ideal lipids and I took this very seriously I was concerned Oh even more concern was my doctor my doctor on a regular basis was near demanding that I start a regimen of statins as well as other drugs and I was very concerned I’ve been studied neuroscience for decades but I knew very little actually of cardiovascular disease I knew little as to why I was so fat at the time as well so I felt a little bit like these geese wandering around or down the road to try to get to the ultimate in health hit’em eyes by Jack LaLanne at the end of the road I wanted to get there I had no idea how to get there and in a sense all I knew about diet was that Atkins said you can eat all the bacon you want and you get nice and thin and you’ll be healthy says appealing as that was to me I didn’t really believe it and in the opposition you have all the plant-based diet gurus who I had heard they emphasized that saturated or animal fat will clog my arteries and cause me to die at a young age so I had a choice I really felt like I could eat meat and die young but happy I live my life as a vegetarian a very long but miserable life and this is really all I knew ten years ago I decided that I had to take charge of my own health I was not going to listen to any of these diet gurus I decided I need to actually learn the research for myself I could put my PhD and biology to good use and so I began with a few papers which then developed into a few thousand papers and dozens of books on the topic and I want to acknowledge actually that people that I have such a high regard for which I have learned from the organizations I’ve been in and the science writers and the books that they’ve read and this is only a partial list of asked amount of research that I have studied in the past ten years and I’ve distilled that ten years of learning down down to a bit about little less than an hour which we’ll spend together today which I’m going to cover as to what it is we need to be concerned about as far as our food and what do we think really about cholesterol in our blood and should we lower those cholesterol levels with statins so essentially we have a diet heart hypothesis which is the idea that you eat saturated fat it’ll increase your cholesterol and then increase in cholesterol will then cause you to have cardiovascular disease and as you can see here in this cartoon essentially this is just completely wrong it was never based on any good science and it’s been perpetuated really by industry particularly food in the drug industry and so my first phase I’m going to talk about saturated fat diet of saturated fat now it info is our health because it really caused us to get fat have heart disease I’m then going to actually talk about the cholesterol our fear that the cholesterol in our arteries will block them and ultimately give us a heart attack and then the critical question is do we need to lower our cholesterol what’s the evidence of the benefit of a lowering of cholesterol trickily lowering it with the statins which appear to be wonder drugs having such a powerful effect on saving people’s lives from that cholesterol that clogs their arteries and finally I’m going to try to make the point to you that it is not cholesterol cholesterol does not cause heart disease so what’s the alternative to cholesterol that you need to understand what actually does cause heart disease and stroke so a little perspective here and I’m only going to cover the diet briefly because two years ago I gave a talk in Ocala and we’ve actually had great progress in appreciating that saturated fat does not actually cause heart disease so this would be a relatively brief section but this is an incredibly important paper in which dr. George Thorpe reviewed over 100 years of research emphasizing that the ideal diet is a low carbohydrate high-fat diet the best diet for losing weight so this is in the journal the American Medical Association we knew this in 1957 and here this is a very important year in 1961 it is an important finding and this is an epiphany for me when I just saw this carbohydrate induced like Pia Mia what that means is when you eat carbohydrates they are converted to fat and that fat is in your blood and they’re saying how common this is and it was so powerful the effect that they Illustrated it by showing someone’s blood serum so in this case in fact they say this may surprise some people who don’t know the literature and that like quemic plasma that is fat in the plasma occurred when they put a person on a high carbohydrate low fat diet and so you can actually see the fat in the serum here and the same person in this study of multiple people on different diets you now have that same person put on a high fat very low carbohydrate diet and the same person now you’re looking at their serum is clear they’re emphasizing it’s from the same person so it’s very clear we have known for 150 years that a high carbohydrate diet contributes to fat in the blood contributes to obesity so that 1961 is important because something else happened in 1961 we had this fellow who I’ve talked about before his name is Ancel keys and this is 1961 he is on the cover of Time magazine he is the spokesperson for research in America he is the dominant figure and look at what he’s saying here in the Time magazine article Americans eat too much fat too much saturated fat it increases blood cholesterol and damages arteries so Americans need to cut back on the fat to be able to control their cholesterol you realize this is completely contrary to everything science had shown for the previous century he made this up it’s amazing here is the minute he’s being interviewed he is seen as an expert and I point out as well he didn’t take a single course in cardiovascular disease or nutrition in college he had a bachelor’s degree in economics and a PhD in fish physiology this is the man that was leading American nutrition science into the 1970s and he was totally wrong now it would be an anecdote to history to me he said well we know he was wrong and yet if you go to the American Heart Association website right now you will see them demonize saturated fat they will say the saturated fat increases your cholesterol which it doesn’t there is no evidence for that and it will increase your risk for heart disease and stroke not only that they’re saying keep your percent of saturated fat very low they’re still recommending margarine over butter they are completely out of step with modern research so it was Ancel keys who came up with this idea of the Mediterranean diet the Mediterranean diet supposedly is a diet of the Italians and the Greeks in which it’s very low in fat lean meat and olive oil and that’s why we’ve got the heart there in Italy well let’s look at the actual data does the data to the data support what Kees said about saturated fat you actually have data points here from every European nation with the average amount of saturated fat these people consume and the rate of death from heart disease and what you find is an actually negative correlation that is the more saturated fat these people eat the lower is the risk of heart disease it’s a complete opposite of what Ancel Keys says is the opposite of what the American Heart Association says now and let’s take it to an extreme the most extreme data point are the French those horrible anti American Heart Association French people will have 40% of their calories from fat and they have the most saturated fat of any country far more saturated fat in their diet than Americans and so we have extremely high saturated fat and I love this quote from th Huxley’s of the great tragedy of science the slaying of a beautiful hypothesis by an ugly fest the entire country of France is an ugly fact and so what should happen when you have a hypothesis in science is you change the hypothesis when the data don’t fit the hypothesis but what does the American Heart Association what do nutritionists in general do they just sweep it aside and they call it a paradox we’re going to take 60 million people and just put them into a box and say well we just can’t figure that out it’s a paradox let’s ignore them and what is it that the French consume so they have extreme amounts they eat animal products liver and animal food and in fact the preference of the French the three primary ingredients in French food are butter butter and butter and flavor so with all that saturated fat all the French women look like her but what is so annoying about her is she’s so terribly thin so the French paradox is that people have a low rate of heart disease in France despite consuming so much saturated fat but another aspect of it is how terribly thin they are and so when you look at obesity around the world Americans are the fattest people in the world that’s us right up there and we are still the fattest with the latest news and we eat the most low-fat and nonfat food of any people in the world and here are those damn French less than 10% of them are obese so that not only not having heart attacks are also not fat so it’s completely inconsistent with the diet heart hypothesis you still see that fear of egg yolks egg yolks we have this love/hate relationship with the egg yolks so much cholesterol so much saturated fat but they taste so good and so what you’ve got is entire industry based on the idea that the egg yolk will kill you and this right now you go to the Cleveland Clinic this is their recommendation egg whites have egg yolks have cholesterol and saturated fat you want to avoid that there’s absolutely no science to justify this fear of the egg yolk and so in fact I give you an example meta-analysis of a large number of studies which shows absolutely no relation between egg consumption and risk of heart disease but take it a step further there’s a magnificent study that was published with two groups both on a low-carb really good diet but to one group they added three eggs a day which happens to be three times more per day than the American Heart Association recommends because if they say you have to fear cholesterol in the egg well the group that had the extra eggs per day showed a greater weight loss greater reduction in blood pressure a greater increase in actually what’s called the good cholesterol which when it’s higher you see less heart disease and there was no overall difference in total cholesterol or LDL which is called the bad cholesterol so in fact consuming eggs is something you should have if you’re at risk for heart disease again completely opposite to the way people have been told about this now the epidemiological work is truly atrocious this is when you hear on the news that people eat lots of meat died young that’s the epidemiological work and here is one example it sounds so impressive half a million people you find out what they eat those the the most meat they die young that’s the lesson don’t eat red meat well this is one example of a truly atrocious study what they found is a very small increase in mortality cancer mortality and cardiovascular disease mortality and assessing the diet of half a million people but when you actually read the study it’s remarkable to see the findings this is what those people look like this tells you about their lifestyle paper after paper demonizing red meat shows what kind of people eat the most hot dogs and the most baloney these are people basically were sedentary they’re fat and they smoke okay and along with the hot dogs are eating a whole lot of breads and a drink in a lot of soda and have an ice cream so the lead eating lifestyle is unhealthy and it’s remarkable to me that these people don’t separate the lifestyle from the specific food ingredients and so the carefully conducted studies have shown there is no relation of red meat consumption to heart disease but there was actually one other thing about this study that I need to point out the people who ate the most meat actually ended up in the most car accidents so there’s no other conclusion than to say read me will give you a heart attack and it makes you a bad driver this is the problem not distinguishing Association from causation it’s the lifestyle that is unhealthy for the people who eat the most belonging so here I am actually now on that road ten years later understanding a bit more about the science the important thing about the Atkins diet or in general low carb diet is when these studies are done it is a single manipulation you have overweight people you don’t change anything other than restricting carbohydrates they lose weight the biomarkers all move in the right direction now the the low-fat plant-based diet researchers as the typify here by Dean Ornish the studies consistently involve multiple factors you have people who explicitly are taught how to reduce stress they exercise more they’re totally less sugar they stop smoking oh and by the way they become vegetarians so what is it that’s helping their health well what they like to point out is that they’re cutting out the red meat but there are so many manipulations that go on so many factors and every single study involving the plant-based lifestyle is so terribly flawed because you can’t point to any one factor that makes the difference and I have to say I’ve written to Dean Ornish many times and he doesn’t seem to appreciate that I’ve told him how terribly flawed his studies on but the bottom line is the low-carb diet works and also scientifically it’s better and so I’m kind of bringing this to a close without covering too much because we have made great progress and this editorial just came out last month summarizing so much of the recent work written by a cardiologist as well as other outstanding scientists in the field and bottom line is the top line the bottom line is the top line that’s right they’re saying saturated fat really does not cause heart disease the reviews are out now and the tide is clearly turning and so now it is okay to eat butter again and not to have to eat margarine and so to bring this first section to a close what is very clear is the good science has shown that saturated fat per se does not cause heart does not increase cholesterol thereby increasing your risk of heart disease now we get to the cholesterol okay is that cholesterol in your arteries therefore going to clog it and cause you to have a heart attack well I was at a talk recently given by Eric Westman in which he talked about how extraordinary the low carb diet is to reverse a metabolic syndrome people lose weight their blood pressure drops everything moves in the right direction a clinician pointed out this one increase right here which goes in the opposite direction that’s LDL so this person is incredibly healthy but it’s because the LDL the bad cholesterol went up well now they’re at greater risk for heart disease so that’s the great concern this is a fantastic review of just how wonderful low-carb diet is but the LDL is the great concern people have well that comes in part from a fear of cholesterol and this is a very influential study published in journal American Medical Association 1986 and what they showed and studied hundreds of thousands of people follow them for many years and looked at their rate of heart attacks according to cholesterol level so you have people are extremely low to extremely high cholesterol and what you find is this increase in the rate of death from heart disease any small increase in cholesterol is associated with increase in death from heart disease and they made that point in their paper that a 1% increase in cholesterol is associated with a 2% higher risk so this is part of where that fear of cholesterol comes from this is a frightening graph so I actually looked at the data and said well what’s the actual risk how many people actually had heart attacks how many actually died and so I’m now graphing the actual data from the paper and so here you are looking at the blue bars the blue bars show the actual percent of people who did not develop heart disease based on their cholesterol level so the lowest to the highest this is the actual rate of people who did not develop heart disease and they’re almost all at a hundred percent meaning almost no heart disease well to make this a little easier for you visually I’ve drawn a line right at 100 percent and you see that microscopic difference there that is a 400% increase in risk of dying of a heart attack that’s what this red line is created from this is derived from that now how did they do that and why did they do there’s another question so when you look at the actual data almost all people down at the bottom here did not die of coronary heart disease 99.7% so 0.3 percent died of coronary heart disease at the highest level of cholesterol 98.7 did not die of heart disease so across the entire range of cholesterol the difference is 1% in the rate of people dying and so 1.3 percent of the people died so how do you turn that into a 400% difference will you take the extremes you take this 1.3 percent and you divide it by 0.3 percent that is 4.13 and that’s how you come up to this red line up here you create a 400% increase in heart disease by dividing one ratio into another and this in great part is why people have feared cholesterol because of this kind of data min population now let’s go further okay this is the highest level cholesterol and you see almost no heart disease in these people so let’s actually look at what’s called a disease in which people have extraordinarily high cholesterol two to three times normal levels of cholesterol which is called familial hypercholesterolemia and any medical suit student can tell you that if you got this disease you’re going to die of heart disease because your cholesterol is so extraordinarily high and so here you have a paper from around 1951 showing high cholesterol is ultimately going to kill you because the cholesterol gets deposited into your artery well so therefore we make prediction people that have this disease should die young from heart disease and if we lower their cholesterol they should be able to live longer well here’s the very first paper looking at longevity in people with this disease 1966 in this prestigious medical journal medicine in which they looked at a large number of people diagnosed with familial hypercholesterolemia no evidence that having extraordinarily high cholesterol shortened someone’s life that people with this supposed disease live into the seventh and eighth decades and there are many other studies I can show you it’s only because of time limit that I’m saying this is not an anomaly so I’ll show you another one in which you have cholesterol levels and people and then you look over 20 to 30 years and you look at their health and longevity so here is a study which I had blood levels over the course of 20 years thought a large number of older people and what they found was greater mortality in the older people who had low cholesterol significantly greater mortality in those who had low cholesterol compared to those with the highest cholesterol and I love how their interpretation we have been unable to explain our results this is really great they’re saying yep everybody told us cholesterol is supposed to kill these people and they’re living so damn long and so there are numerous other studies again this is not an anomaly this is consistent in the literature and in fact to summarize this I’ve worked with some outstanding colleagues we published this paper last year in British Medical Journal in which we reviewed every paper ever published on LDL cholesterol and longevity and what we found is not a single paper in which people died young having high KL DL every single paper the people with the highest LDL lived as long and even longer than the people with low LDL and that is summarized here and this is a quote from our paper since elderly people with high LDL live as long or longer then why would anyone want to lower their LDL and shorten their lives and so in the second phase does cholesterol therefore clog your arteries and cause you to have an early demise the answer is clearly no LDL does not clog arteries does not cause heart disease does not kill people well now we get to the big Bugaboo okay well what about lowering your cholesterol I mean the statins are the wonder drugs showing a 36% reduction in rate of heart disease so what about lowering your cholesterol does that help you then to have less heart attacks is that going to enable you to live longer all right well where did that come from where did the idea of lowering cholesterol come from as being heart healthy well once again we have Ancel keys Ancel keys had the idea that if we can lower cholesterol then people will be healthier be less likely have heart disease even talk about hypercholesterolemia and in fact he did find that when you consume corn oil you will lower your cholesterol and that is a fact consuming corn oil lowers your cholesterol this is what he found in the 1950s so he suggested in that paper then people should consume corn oil if you lower your cholesterol by eating corn off you’re less likely than to have a heart attack and that was actually tested here is a study published in British Medical Journal 1965 they had two groups of people they had already had heart disease and they were at high risk of dying of heart disease they had one group that was put on a low cholesterol low fat diet and they had a couple tablespoons of corn oil per day per day so they got the best advice of all the other group as you see here they say no advice was given to the control patients and it’s a bit like well really sorry about this but we need a control group so you have to go home and die we can’t share with you our wisdom about cholesterol and all so you’re going to have a high rate of heart disease you’re going to have high cholesterol and you’re going to die and the outcome was quite nice as far as the cholesterol and so the people who were on the corn oil the low-fat low-cholesterol corn all died did have a significant reduction in their cholesterol levels and that in fact is why corn holocene is heart healthy whereas the ones that went home to die and basically could eat whatever they wanted had no change in their cholesterol levels so the study was success as far as reducing cholesterol but then when you look at the outcome the outcome is very straightforward to stay in the study you have to stay alive if you die you’re out of the stuff okay so we’re looking at the percentage of people that were still in the study years later okay so or if you have a heart attack you’re out of the study so now we look at these two groups and look at who’s still in the study and so the group that was told to go home and die we still got 75% of them but the people on the low-fat low-cholesterol corn oil died only half of them are left so twice as many people had heart attacks and died in those that had the corn oil and this actually has never been shown to be flawed there is no study that has shown any benefit of corn oil other than lowering your cholesterol so I like this this quote from John Abramson at Harvard University dying with corrected cholesterol is not a successful outcome so the goal is survival not cholesterol reduction and the authors of the paper made it very clear their findings were unequivocal corn oil cannot be recommended in the treatment of ischemic heart disease so this was the first drug given to people to lower cholesterol and it totally failed it is still heart healthy why is it heart healthy because they pay the American Heart Association a whole lot of money and it lowers cholesterol but it has never been shown to be heart beneficial now decades passed by which I don’t need to cover the details decades of disappointment it’s not that hard to lower cholesterol levels and drugs and die persisted then for twenty years and they totally failed and that’s actually reviewed here in the introduction to this paper published in 1984 many trials lowering cholesterol have been conducted they call it inconclusive I call them a failure so the trials all failed despite the reduction of cholesterol this was going to be the ultimate study in this study you have a half a million men we’re all assessed got blood blood cholesterol levels you took the five percent with the highest levels of cholesterol and so you have the top five percent therefore these people consider to be on their deathbed and you give them a drug called a stye Ramin which very effectively can lower cholesterol levels you follow them for seven years and then you look at the outcome in terms of cardiovascular events this was a major finding this was a watershed event this was the first time that reducing cholesterol actually saved lives and this is copied and pasted directly from the study Journal American Medical Association the group that had lower cholesterol had a 24% reduction in death not just heart attacks this saved lives what I’m also going to show you cut and paste it directly from the paper is that the risk of death was actually not reduced in the treated group how can you reduce death from heart disease by 24 percent but overall no lives are saved this doesn’t make sense does it okay we’re going to find out how they did that so I’m showing you the data for the two groups but I’m presenting the data in terms of subjects that did not have an adverse event such as death is an adverse event we’ll all agree on that so not having an adverse event means you survive so the rate of survival is almost 100% and absolutely no difference between the groups that’s why there is no mortality benefit so where it’s kind of a Where’s Waldo kind of thing you know where is that 24% benefit in comparing these two groups well it is right there this is actually a 20 you see that microscopic difference between those bars that flows the watershed event that’s the 24% reduction in death from heart disease yeah really I was as surprised as you are now I’m looking at all your faces only really so how do you do that well the actual difference in these groups is 1.6 percent versus 2% rate of death 0.4 percent I understand they started with a half a million people they ended up at the top 5% 3800 that had the highest cholesterol of all ultimately the difference between two groups is eight men which was not statistically different that’s your 0.4% in that column and how do you turn 0.4 percent into 24 percent a little bit of statistical magic and hijinks you divide the difference between the groups 0.4% and for no good reason whatsoever you divide that by 1.6 percent and when you do this manipulation you end up with 24 percent you have now reduced deaths from heart disease by 24 percent but the real difference in the population was trivial was 0.4% perhaps you’re getting a sense of indignation and maybe this is building you as well this is what I’ve learned in the past ten years so if I were conducting this study and the evidence was so clear that lowering cholesterol really had no effect whatsoever I would have basically said we failed we need to look somewhere else this is a hundred and fifty million dollar NIH study fund in the 1970s it showed no real benefit of reducing cholesterol and what do they do they come out and say it’s a total success we now can stop heart disease is what the leader the director basil Rifkind said this is a turning point in cholesterol heart disease research that is a direct quote from the article and they said based on this finding we now need to develop drugs that will lower cholesterol even more effectively and that ushered in the statin era so understand everything leading up to the statin area was a total failure reducing cholesterol had absolutely no benefit whatsoever so now we have the statin era and here I’m going to show you one of the best trials ever I’m not looking for subtlety here I’m going to show you the absolute best trial showing the greatest effect of lowering cholesterol with a statin this one is lipitor this is the drug study that propelled lipitor to generate a hundred billion dollars in revenue this is where they were able to reduce the risk of heart attack by 36% so you can feel really good thinking of now reduced by over a third the likelihood that I’m going to have a heart attack because I’m on lipitor so let’s look at that study here again I’m showing you the data just as I did for the 1984 study the difference between atorvastatin which is lipitor versus placebo you see these microscopic differences between the the lipitor which is red and so again we’re looking at the rate in which an adverse event did not occur so we’re looking at the people that didn’t have heart attacks didn’t have a stroke didn’t die and they’re almost all at a hundred percent so where is that 36 percent benefit that’s in the lipitor ad it’s right there once again we’ve got a 36% effect we’ve got a huge effect with an actual microscopic effect when you actually look at the population at risk so how do you turn that into 36 percent reduction well if you actually look at the data you’ll see how they did this you’ve actually got a 1.1 percent difference between the drug and placebo so about 98% of the people on the drug did not die of heart disease and 97% on the placebo did not die of heart disease a 1% difference and so how do you now turn that into a 36 percent difference because you got that right here this has 36% did anyone notice along the bottom the blue font on the blue background let’s expand that a bit they’re actually showing you that it was a 3% memorize the 97 percent versus 98 percent so the real data are in the ad you notice it’s a blue font on a blue background I think the lawyers insisted they put this one in there so the real difference is 1 percent and it’s right there in the end so it’s 1 percent and it’s 36 percent at the same time the same results can you imagine well let’s actually show you how they couldn’t for sure how they calculated that again you take the difference 1.1 percent between the two you’re divided by 3 percent for absolutely no good reason whatsoever except that it greatly inflates the outcome so now you can say that that difference is a 36% reduction in the rate of heart disease are you getting angry can you imagine if you had a financial adviser investing for you and at the end of the year you’ve made 1 percent on your investments and he says don’t worry I’ve been doing 36 percent better than I did last year it’s it’s the same thing it’s a manipulation of the data it’s an obscene manipulation of the data and so think about it what this is actually showing is that you treat 100 people with lipitor one person will have one less heart attack the other 99 will have no more benefit and if they had the placebo and so I’ve changed the ad to be more accurate obviously is very reasonable so lipitor reduces the risk of heart attack by 1% if we had truth in advertising that’s what the ad would look like I don’t know if you be as amenable to taking the lipitor when you got all the adverse effects which I’ll get into if you think you’re only going to have one percent chance of having one less heart attack the latest drug because lipitor has gone off patent it’s been replaced by presto which is now generating billions of dollars lots of people now choosing crest or over lipitor because the effects are phenomenal the person who led this study and this is the study that kicked off the crest are the Jupiter study said spectacular effects John cast the line who by the way very well paid by the drug industry is telling you about the results of his study it is spectacular it’s not only reducing the rate of heart attacks it is preventing a first heart attack and perhaps you’ve seen the ads this woman is just so happy she’s gotten down with Crestor ok so let’s look at this study that you better study you know what’s coming right ok well first I want to show you how doctors will see the results of this study at a conference so this is the appearance of the Jupiter findings that would be delivered at a conference and so you’d see this incredible difference between the groups so this is the incidence of adverse effects so there are many more adverse effects in the placebo group compared to the Crestor it’s a 44% difference so this is how it is presented in conferences the important thing is now we take a closer look the stud was actually terminated at 1.9 years because so many people were getting such a great benefit they felt an ethical obligation to stop the study at 1.9 years so the graph actually stops here this is the 44% difference and what you’re looking at here is actually the incidence of adverse events which actually goes up to 1.0 so if everybody had a heart attack this would be at 1.0 so this is looking at the rate of heart attacks between the two groups this is a 44% I want to prepare you okay the graph I’m going to show you next is not my graph I have cut and pasted it directly from the New England Journal of Medicine article showing the spectacular results that John castellane said we get from Jupiter just yeah take a gander at that okay this is showing the rate of adverse events this is showing you and so if everybody had a heart attack the line will be up here and would be great if everybody getting the placebos up here the crest doors down here that would truly be a wonder drug this microscopic difference right there that was the previous graph that you saw you take these two lines and stretch them apart because you’re only looking at this range in the previous graph this is the difference between Crestor and placebo if you are taking crest or you can look at this graph and say why I mean this is the difference between taking Crestor and taking a placebo which is essentially nothing so again we look at the data and we have this little fella and this little fellas looking at the data and I got to tell you I’m looking at your faces and I’ve actually lectured to cardiologists and they have the same face you have like really and I would really love for John Castellon to explain to this little fellow how this is truly spectacular and we have stopped heart attacks from occurring really again looking at the data this is actually the Jupiter findings the difference is 1.2 percent between the treated in the placebo group incredibly trivial but here you take the 1.2 percent which is the difference divided by 2.8 which is the difference in placebo in 100 and you’ve inflate it 1.2 percent to 44 percent do you have a sense of the trail that the experts really have not been forthcoming with a total miniscule effects that statins truly have on coronary outcomes now they did find something they weren’t looking for this but people were reporting that they developed diabetes this is a separate part of the study they were not looking at this but doctors were reporting that people on Crestor were developing diabetes and they were obligated perhaps to include this in the paper this is simply a statement and the results for some reason they didn’t take the great incidence of diabetes and inflate that and look at the rate of diabetes with relative risk well I’ve done that for them and so when we look at the rate of diabetes developing in these people what we have is a 24% increase in the rate of diabetes in the Jupiter study so when you take crest or you are increasing the likelihood that you will develop type 2 diabetes now there are many studies that have confirmed this finding when you actually look at it when you get people’s blood sugar before going on the statin and you follow them for years what you find is a significant increase in diabetes typically twice the rate of diabetes so in this paper which I think can for giving me just today this paper is consistent with others but what’s so important about this paper a few things there is a doubling in the rate of diabetes in people who take the statins so you’re looking at 12 and a half percent of statin users versus 6% develop diabetes and this has been consistently found so it is not a trivial doubling this is going with 6 to 12 percent they’re also emphasizing here there are no cardiovascular benefits so there studies that review found there was no overall benefit cardiovascular disease and I want to emphasize the difference here and I’ve said this in the very first slide how is it that your opinions are produced what is it that influences your opinions what you find consistently is those studies that have shown benefits of statins are very well funded by Big Pharma when you find people showing adverse effects of statins as this one is there was no explicit funding from Big Pharma the work was done at the VA at North Texas and so I really admire a man sees group has been showing adverse effects of statins and they take no money from Big Pharma now 1% you could still kind of cling to that well I’m still getting a benefit of statins I’m a little less likely to have a heart attack and if there were no adverse effects if there was no diabetes well you can consider it but the peer-reviewed medical literature here I guess have some of them have shown so many adverse effects of statins erectile dysfunction reduced testosterone kidney disease and everybody knows about the musculoskeletal problems the joint pain the muscle pain and when you go to your doctor and you’re honest at and you say I’ve got muscle pain and your doctor says what would you rather have muscle pain or a heart attack isn’t that what they’ll say to you well the reduction in heart attack is so trivial that that muscle pain is pretty important and it’s very consistent and a high percentage of people and as well other adverse effects have been published and here I want to point out that normally the drug companies stopped the studies at about two to three years which is too soon to be able to see cancer develop in people but when you look at a term study here you have ten years of looking at women who are on statins what you find is that after about ten years you then see over two times the rate of breast cancer in the women who are on statins compared to those who are not on statins so it takes time but there’s a clear connection of statins of cancer in women as well as in men and so do you think you’re going to live longer the evidence is very clear there is no evidence at all that statins enable people to live longer of course because they’re entirely ineffective and they have the adverse events of course you’re not going to live longer so there is no mortality benefit to taking the statins and it’s right here in their conclusion no evidence of benefit of statin therapy all cause mortality much of what I presented here because I want to emphasize you will leave here tell your doctor I heard this guy tell me that statins are useless and your doctors can say well who is that guy I’m right and he’s wrong you got to listen to me I’m the doctor well we have published what I presented to you here in a high-quality peer-reviewed medical journal expert review of clinical pharmacology couple years ago I reviewed much of what I’ve covered in in this lecture in which we covered that elevated levels of cholesterol are not atherogenic means they don’t cause heart disease all people with high cholesterol live longer than people with low cholesterol we described in that paper how deceptive the entire industry has been using relative risk and I’ve talked about how there are small benefits of statins that are offset by their adverse effects so there are slight benefits clearly offset by the adverse effects and finally just a bit like well what is it you need to worry about and what can you do about reducing the likelihood of having a heart attack here is a study which you look specifically at LDL the LDL is extraordinarily high it’s supposed to be below a hundred these people have it about 250 there’s no difference in cholesterol LDL HDL or triglycerides and these are people who have one group has heart disease and another group doesn’t know difference in their cholesterol between the two groups what is different in the group that has heart disease clotting factors the people have equivalent cholesterol but significantly higher clotting factors fibrinogen is one factor eight is another these are the proteins that cause our platelets to clump together and those that had more clotting factors are the ones that had the heart disease your blood will clot for a variety of reasons and that ultimately is what causes heart disease and strokes and so here is just one example in which you’ve looked at a clotting factor if I Britain if I branch in here increase on this scale is significantly related then to coronary heart disease as well as stroke and you don’t see anything like this in relation to cholesterol so AR clotting factors you need them when you’re bleeding but when you’re not bleeding they are killing you okay they are blocking your arteries and causing you to die of heart disease and so here just is a bit of a review I won’t go into detail but every risk factor for heart disease basically activates platelets if you smoke if you have high blood sugar high blood pressure stress all increase clotting of your blood and so that blocks your arteries contributes then to heart disease so what you really need to focus on is reducing your blood sugar not smoking reducing your body weight and so these all trigger the clotting that goes on in our blood and so these are the factors that ultimately will make the greatest difference in improving our heart health and you can ignore the cholesterol and focus on lifestyle factors that will minimize the activation of our platelets and cause clotting so to summarise talked about the diet heart hypothesis how it was never based on any good data it became Dogma without actually being rigorously assessed and so rather than go over the details what I want to do is quote people that I have such a high regard for a great respect Gorge man battled with Ancel keys for decades Ancel keys was a bully and he was able to get people to follow him George man on fortunately was not able to make policy but he had this to say about Ancel keys a generation of citizens has grown up since the dye dart hypothesis was launched as official dogma they’ve been misled by the greatest scientific deception of our times the notion that consumption of animal saturated fat causes heart disease that was 30 years ago now Paul rush dr. Paul Raj the colleague of mine talking about atherosclerosis and the flaws in the research and he’s published here the belief that atherosclerosis due to high cholesterol has been perpetuated by powerful forces using tactics to preserve the profits and reputations of those who promote this doctrine and finally I’ve had the pleasure to work with who fear ivanov published papers with him which he stated the diet heart hypothesis is sustained by social political and financial institutions which have little to do with science or any established success in public health so I feel a bit like Isaac Newton said he was standing on the shoulders of giants to see farther and so well really everything that I have learned in the past ten years to paraphrase that I’ve stood on the shoulders of giants to be able to give you this presentation today and to understand that I’m very glad but I never took a statin that I was able to reduce my triglycerides by 75% I was able to increase my good cholesterol and all my biomarkers have moved in the right direction I’ve been able to lose weight all by what I have learned about changing lifestyle to be able to optimize biomarkers and I have about a chapter in this book which I highly recommend title is fat and cholesterol don’t cause heart attacks and statins are not the solution it’s about as straightforward as can be and you’ve got chapters written by experts from around the world I thank you for your attention [Applause] are there any questions okay the lady right here my concern I work with a hospital system and my concern is that were mandated to prescribe statins for all strokes and heart attacks and in this era of hyper performance is probably coming to cardiologists and neurologists too are we seeing anything about the literature changing or the protocols changing no you are not seeing any changes whatsoever in fact things are getting worse we have about 25 percent of all adults are on statins and we’re looking at approaching it will be about half of all adults will be on statins largely because the drug companies to a great extent control the media and have a great influence over medical education so the information I’m giving to you now has not been really been disseminated very well now it is not mandated that people be on statins that’s your hospital policy and so really what you need is someone to be able tell the administrators that what they’re giving out to their patients is not good medicine so what you just said was that statins are mandated as a part of standard of care you need to actually understand the guidelines do not mandate statins they’ve been very clear about that they say statins are not required I think frankly they’re just covering their ass on that one but it is it is really not mandated at no level has it been mandated that is actually hospital policy so we could get into as far as the details but bottom line is every patient has the right to decide what he or she medicine he will she will take and at the hospital says everybody has to be on statin well that’s their choice and that’s a bad choice we’ve got one right here in the front our wine drinker reducing his platelet coagulation with the alcohol good for you you mentioned something about right at the end about platelets actually maybe being an issue is donating blood and platelets helpful that’s a good question so see platelets are that double-edged sword we need them if we have a hemorrhage every wounded but they’re basically killing us so platelets are really donating platelets is probably a very healthy thing to do I don’t know of any research showing difference between donors and non donors but clearly it’s something that most of our lives we don’t need those platelets so yeah I think it’s probably very healthy I guess a lot to move around the room get to the other side next just to reinforce how malicious the pharmaceutical companies can be and you probably read this a while back and I don’t know when it was they succeeded in maneuvering the normals for cholesterol down ten units right and as I remember the paper it resulted in billions of dollars of profits for them because when someone runs a cholesterol and the physician looks at the values what he sees is many more patients have exceeded the lower levels and the drug companies were instrumental and lowering these normals but it’s absolutely right the levels for prescribing statins have been dropping over the years adding millions of people to those eligible for those statins and there’s been an outcry against that but it’s really been smothered in a sense by those who are paid very well by the drug companies and these are the people in the position of authority one other quick question does aspirin influence your clotting factors at all yeah aspirin actually does reduce clotting and it’s totally ineffective at blocking heart attacks what’s a shame and there’s another talk I could give tens of millions of people are taking a daily baby aspirin and they think they’re less likely have a heart attack the FDA has actually blocked they are aspirin from saying that you can reduce heart attacks by taking a baby aspirin when you see that commercial in which the person takes the aspirin and then they’re told you know you or they get the note that says you won’t have a heart attack if you take the aspirin it’s very deceptive there is absolutely no evidence at all you go to the FDA website there’s no evidence of taking a daily aspirin will reduce the risk of a first heart attack if you’re on the way to the hospital and you’re having a heart attack and take an aspirin because right mo and all that clotting is very bad for you but the evidence is very weak even following a heart attack when you look now months later very weak that an aspirin makes a difference so the problem is the aspirin alone is not sufficiently reducing the cly clotting involves multiple actions on aspirin acts only a subset of those let’s go on the side as the high heart calcium score another reason to take a statin or is it the same as a high cholesterol so first the calcium score is when you actually look in the arteries and you can actually measure how much calcium is in there and it’s potentially a value if someone is extremely high two three four hundred there is some Association of calcium in the arteries the remarkable thing to me is it has been confirmed that statins increased calcium in your arteries there’s a fact that it’s amazing in this world and when the study came out and was published that statins increased calcium in your arteries they were lauded as saying this is wonderful because now it’s going to stabilize your plaque it’s exactly I could quote you from their media article so statins do not reduce calcium in the arteries the best way to reduce calcium in the arteries is by eating gouda cheese I’m not paid by the Gouda cheese company but Gouda cheese has lots of vitamin k2 vitamin k2 will direct that calcium into your bones and away from your arteries how about on the other side I think we got someone very enthusiastic back there Oliver over there can you talk about the correlation between omega-6 and heart disease I’ve seen enough studies it shows a correlation point nine nine so what you’re actually referring to when Omega 3 is found at high concentrations particularly in fish and those who eat lots of fish will have a higher ratio of omega-3 omega-6 is found in vegetable oils and grains and I think what’s really important is first omega-3 is very healthy and it actually does reduce coagulation that’s part of the reason I think why it’s healthy and the higher the omega-3 relative to omega-6 means you’re actually going to have less coagulation so that’s important as your omega-6 goes up what that means as you’re eating a whole lot more vegetable oil and a lot more grains which intrinsically is unhealthy so I think what we want to focus on what are people eating rather than the components one more question about that the fellow over here with the beard he’s been done I think he’s got something profound to say he’s had his hand up the whole time you keep emphasizing decreasing platelet coagulation what would be the top three ways to do that for the members of the audience okay a great great way to finish this off so the platelets are extremely extensive when you get stressed and actually part of my research is stress and brain and heart disease when you get stressed quite literally your blood clots and that is why stress is related to heart disease because you’ve got clots passing through your blood vessels so part of this and actually what dean ornish says is reduce your stress so you’ve really got to control the stress when you exercise you actually break clots down so exercise is really fantastic high blood sugar activates platelets and so you want to get your blood sugar down being obese okay obese people have more platelet activation than thinner people cigarette smoking triggers platelet activation so all of the basic recommendations that people should follow to reduce the likelihood of having a heart attack other than lowering their cholesterol all the other recommendations for lifestyle changes they will all reduce platelet activation and therefore that’s that’s why the others are so effective on that note let’s thank our speaker you

Randall Smitham