David Diamond

Rebuttal to: People's Pharmacy guest dispenses bad advice on statins

By David Diamond

On July 30, I shared a podcast on the "People's Pharmacy" with Dr. Steven Nissen, in which we discussed research on diet, heart disease, cholesterol and statins. There has been a firestorm of controversy in response to my remarks on the program, including accusations by Dr. Navar in an op-ed and by Dr. Wachter at the podcast website that I made "dangerous claims about cholesterol and heart disease" and that the "misinformation" I conveyed to patients "will increase their chances of having a heart attack or stroke". As a scientist with a Ph.D. in Biology and over 100 publications in medical journals, I find for the first time in my career to have to defend the validity of my research. This rebuttal is important because I cannot permit the specious criticisms of my podcast by Drs. Navar and Wachter to go unchallenged. 

The first issue my critics raised is whether I, with a specialty in neuroscience, am competent to provide a scholarly perspective on cardiovascular disease. As I stated in the podcast, my interest in heart disease is personal and professional. Ten years ago I was diagnosed as being at high risk for developing heart disease because I was overweight, my triglycerides were at astronomical levels (750 mg/dl) and my HDL (the "good cholesterol") was dangerously low (33 mg/dl). My doctor urged me to go on medications, including a statin. Instead, I decided to study the medical literature on diet and heart disease to understand why my blood lipids were abnormal. In the past decade I have read thousands of papers on these topics, and I have become educated by the work of outstanding researchers, including Drs. Ravnskov, Kendrick, 
Golomb, McCully, Malhotra, Okuyama, Roschde Lorgeril, Dashti, Vos, Mann, Westman, 
LustigAbramson, Wainwright, Langsjoen, Redberg, Miller, Krauss, Mascitelli, Eenfeldt, Harcombe, Graveline, Feinman, Volek, Phinney, Champ, Mansi, Seneff, as well as the scholarly works from writers, including Groves, Taubes, Yoseph, Davis, Brownstein, Kauffman, Perlmutter, Teicholz, Colpo, Atkins, Banting and many others. 

On a personal level, I learned that my excess weight and abnormal lipids were caused by my excess carbohydrate consumption. By reducing my consumption of high glycemic foods, such as sweets, bread and potatoes, I reduced my triglycerides by 75%, nearly doubled my HDL and lost weight, without medication.

 On a professional level, I have shared what I have learned about diet and cardiovascular disease with the public and medical audiences, with on-line lectures and interviews, first in 2011, and then two in 2015, and in hospital grand rounds and invited lectures at international medical conferences. In one example, I delivered the keynote lecture on statins and heart disease at the World Congress on Diabetes & Obesity in Riga, Latvia. My lecture on statin research was so well received by the clinicians at the meeting that they honored me with their award for "outstanding contribution to science".

My research accomplishments appear to have escaped Drs. Navar and Wachter's notice. They criticized the Graedons for permitting me to be on the program, but they ignored the links the Graedons provided to two of my publications on heart disease, both of which were published in peer-reviewed medical journals (BMJ Open and Expert Review of Clinical Pharmacology).

In one of the papers, my 16 co-authors (all of whom were MDs and/or PhDs, including cardiologists) and I provided a rigorous assessment of the hypothesis that people over the age of 60 with high levels of LDL-C (the so-called "bad cholesterol") would have a higher rate of death from heart disease and all-causes. To the contrary, we found that elderly individuals with the highest levels of LDL-C had an equivalent or, in most cases, a lower rate of death, than elderly people with the lowest levels of LDL-C. This finding was reported widely in the media, which appears to have escaped Drs. Navar and Wachter's attention. It was on the basis of our findings in this paper that I stated on the program that high levels of LDL are associated with greater longevity, which is simply a restatement of a fact.

Since high LDL levels are associated with a reduced rate of mortality (as well as reduce rates of death from cancer and infectious diseases), then the burden is on Drs. Navar and Wachter to explain to their elderly patients why they would recommend lowering their LDL levels when those with the highest LDL levels live longer. 

A second publication of mine was a major topic of discussion on the program. In this paper, Dr. Ravnskov and I described the deceptive approach statin advocates have used to exaggerate the appearance of the effectiveness of statins in reducing coronary events. A prime example of this form of deception was used, perhaps unknowingly, by Dr. Navar in her op-ed. She stated that "statins can reduce the risk of cardiovascular events between 20 and 30 percent". This figure sounds impressive and may convince her patients to begin a statin regimen, but is Dr. Navar aware that the actual benefit produced by statins is only a 1% reduction in coronary events compared to placebo-treated subjects? I discussed on the program how statin advocates transform the 1% effect into a 20-50% effect using statistical manipulation of the data, which is also provided in media coverage of our paper.

Dr. Navar scoffed at my suggestion that consumption of foods such as cheese, eggs and chocolate may reduce heart disease more effectively than statins. Since statins produce almost no real benefit in reducing coronary events it would not take much of a beneficial effect for any treatment to produce a better outcome than is found in statin trials. More to the point, research has demonstrated the health benefits of the consumption of food rich in vitamin K2 (which reduces calcified arteries), such as cheese and eggs, as well as dark chocolate, which has been shown to produce a substantial reduction of blood pressure in hypertensives.

Dr. Navar stated as a fact that "Studies of hundreds of thousands of adults confirm the safety of statins." Her statement misrepresents research findings on statins. As I discussed on the program, the risk of developing type 2 diabetes can be five times as great as the benefit of taking statins (5% adverse effects versus 1% benefits), which has been confirmed in recent publications. Moreover, we and others have reviewed findings on the adverse effects of statins, with evidence that they extend beyond diabetes to include cancer, liver dysfunction, acute renal failure, myopathy and cognitive impairment.

On the topic of cognition, in another paper of mine published with a group at the University of South Florida, we reported that lipophilic statins which gain access to the brain, such as Lipitor, are associated with the highest incidence of statin-related adverse cognitive events reported to the FDA.

In closing, to Drs. Navar and Wachter, I will paraphrase a statement recently published by my colleague, Dr. Ravnskov, in response to a critique of one of our papers: It must be difficult to accept that your belief that cholesterol causes heart disease is wrong. I suggest, however, that with an open mind and a better appreciation of the real causes of heart disease, you will gain the respect of your colleagues and your patients will benefit from evidence-based care.