Diet Versus Drugs for High Cholesterol

Diet Versus Drugs for High Cholesterol
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Though official recommendations are to first treat high cholesterol with dietary change, many physicians jump right to cholesterol-lowering medications, such as statins, that can have an array of adverse side effects.

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To combat dyslipidemia, which includes high cholesterol, patients have several treatment options that include drugs, diet, and/or lifestyle changes. Drugs are effective, but produce adverse side effects in a significant proportion of patients. Statins, such as Lipitor, are the most widely prescribed, but they produce adverse effects in up to a third of patients. Adverse effects are also associated with the other drugs in common usage.

“Adverse effects may include liver, muscle, and kidney dysfunctions; skin disorders; abdominal pain; nausea; constipation; dizziness; flushing; neurological disorders; and cognitive impairment. On the other hand, therapies based on dietary and lifestyle changes produce little or no adverse effects [in fact, tend to have positive side effects] and are the cornerstone of recommendations by the [official U.S. body]…American Heart Association…[as well as the international guidelines]. Recommendations include reduced intake of saturated fat and cholesterol while increasing physical activity and intake of dietary fiber.”

So, we need to eat fewer animal foods, the only source of cholesterol, and more plants, the only source of fiber.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Kerry Skinner.

Please consider volunteering to help out on the site.

To combat dyslipidemia, which includes high cholesterol, patients have several treatment options that include drugs, diet, and/or lifestyle changes. Drugs are effective, but produce adverse side effects in a significant proportion of patients. Statins, such as Lipitor, are the most widely prescribed, but they produce adverse effects in up to a third of patients. Adverse effects are also associated with the other drugs in common usage.

“Adverse effects may include liver, muscle, and kidney dysfunctions; skin disorders; abdominal pain; nausea; constipation; dizziness; flushing; neurological disorders; and cognitive impairment. On the other hand, therapies based on dietary and lifestyle changes produce little or no adverse effects [in fact, tend to have positive side effects] and are the cornerstone of recommendations by the [official U.S. body]…American Heart Association…[as well as the international guidelines]. Recommendations include reduced intake of saturated fat and cholesterol while increasing physical activity and intake of dietary fiber.”

So, we need to eat fewer animal foods, the only source of cholesterol, and more plants, the only source of fiber.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Kerry Skinner.

Please consider volunteering to help out on the site.

Doctor's Note

I debated whether or not to include this video, since it’s not anything I haven’t covered before (see, for example, What Women Should Eat to Live LongerTrans Fat, Saturated Fat and Cholesterol: Tolerable Upper Intake of ZeroHeart Attacks and Cholesterol: Purely a Question of DietEliminating the #1 Cause of Death; and Statin Muscle Toxicity). I just liked how the researchers summed it up. And, since heart disease is the leading killer of both men and women in most countries (see Uprooting the Leading Causes of Death on how to prevent 14 other top killers), I figured a little repetition couldn’t hurt. 

For more context, check out my associated blog posts: Stool Size and Breast Cancer Risk and Cholesterol Lowering in a Nut Shell.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

37 responses to “Diet Versus Drugs for High Cholesterol

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  1. I debated whether or not to include this video, since it’s not anything I haven’t covered before (see, for example, What Women Should Eat to Live Longer, Trans Fat, Saturated Fat and Cholesterol: Tolerable Upper Intake of Zero, Heart Attacks and Cholesterol: Purely a Question of Diet, Eliminating the #1 Cause of Death, and Statin Muscle Toxicity). I just liked how the researchers summed it up. And since heart disease is the leading killer of both men and women in most countries (see Uprooting the Leading Causes of Death on how to prevent 14 other top killers) I figured a little repetition couldn’t hurt. If you haven’t yet, you can subscribe to my videos for free by clicking here.

    1. The problem is that most M.D.`s know little or nothing about the tremendous impact of diet on health.

      Another problem is that the official recommendations are way too conservative. You can`t expect big results if you just follow the advice to lower your intake of saturated fat and cholesterol; you have to avoid saturated fat and cholesterol altogether.

      Moderation kills! (I think that was Caldwell B.Esselstyn)

    2. Once people went to the doctor when they were sick. Now people go to the doctor to get assured that they are healthy enough. Slightly elevated cholesterol and you get a prescription for statins – and then you are healthy! – NOT!!! Health has nothing to do with medication. Prescription drugs are for sick people. I am not “all up to date on the science here”, but has it ever been documented that otherwise healthy people, with slightly elevated cholesterol, benefits from statins?

      Of course it is a different case, if a person has had a cardiovascular event – then we have a sick person – a patient.

      Healthcare is evolving into a risk-factor system, where healty people take prescription drugs to prevent something that might never happen.

      1. Stefan and all others,
        I thought you might like this new release from The National Acadamies Press:
        Committee on Ethical and Scientific Issues in Studying the Safety of Approved Drugs:
        “An estimated 48 percent of the population takes at least one prescription drug in a given month.”
        Open wide ;-()

      2. Stefan,
        I’m really depressed right now.  Not only am I fighting an uphill battle I may have no choice in the matter in the future.

        This is an exerpt from the publication Family Practice News:

        “In Massachusetts, Physicians Bearing Brunt of Reform Effort.

         The Health Reform Law “An Act Providing Access to Affordable, Quality, Accountable Health Care, essentially requires all state residents to acquire health insurance. The concept behind the reform law “was brilliant,” because it increased insurance coverage and gave patients incentives to get preventive care (I’m not the biggest fan of Preventative Care when it comes to certain screening tests). But at the same time, the law “discincentivizes doctors from seeing patients because the reimbursement is so poor.””

        And the kicker for me, which I have been hearing for a long time is, “The shift to global payment will likely hasten the demise of solo and small private practices.”
            
        http://www.familypracticenews.com/newsletter/family-practice-news-e-newsletter/singleview-enewsletter/in-massachusetts-physicians-bearing-brunt-of-reform-effort/a4bac8aece25b31d091cef54280502df.html

        How will I survive teaching plant based lifestyles.  Because I can tell you now there is no way in Hell that Big Medicine (eg Hospitals) will let me spend quality time with my patients teaching them how to get off their medicines rather than prescribing them.

        Let’s get real here.  I can get a patient in and out of my office in five to ten minutes if I tell them that all they have to do is take “this Pill” and all will be better.  (Just don’t tell them they will be taking that me for the rest of their life and have to follow up about every 3 months for the rest of their life, nor the side effects, nor the cost, nor that they will slowly degrade and cost the health care system even more Billions of dollars because pills for chronic disease don’t stop the progression of disease.)

        But to teach a patient about the disease process and the physiology takes time but well spent time.  But Big Medicine is all about TIME!!!!  Because TIME=MONEY!!  Decreased reimbursements will mean I will have to see 30-40 patients a day just to keep my head above water if I work for Big Medicine.  And then I will have to be happy as I stand by and watch my patients continue on the slow, agonizing path of physical, mental and spiritual decline.

        This is a horrible conundrum to be in.  Are all countries like this?

        If our health care is so good then why are we the worlds leaders in health care spending and nearly the last in quality health care?

      1. If it was old news my patients would be going plant based and stopping the statins. And trust me that isn’t happening. They say their cardiologists want them on them so……

  2. I once suggested to my cousin, an experienced cardiologist and a very people-smart person, that science supports consuming produce over pills to lower heart attack risk. I went over several articles with her and she agreed with my conclusion, but protested that she cannot advise her patients to become pure vegetarians since most of them will think she is crazy and seek another doctor. She claimed that it is important to work with the paradigm of the patient and take a gradual approach to bringing about change. So she does suggest shifting to leaner meats and eating more fruits and vegetables, but also pursues statin therapy, as required to get the cholesterol numbers in the desired range. 

    Given the bias that many people have, what is the best way for a doctor to convince their patient to switch to a whole foods plant-based diet?

    1. I think because people revere docs, they might actually not think poorly of her recommendations for a veg diet. I would present info to support though… Links for veg recipe websites and sites such as these. Book recommendations, too. Give the patients the info and then let them decide but don’t assume patients can’t handle it.

    2. Doctors are not scientists.  they are mechanics.  grease monkeys… asking your doktor to explain first principles of heart lube is akin to expecting your BMW technician to understand Bernouli’s equations.  TAKE RESPONSIBILITY FOR YOUR HEALTH.  Read what you can but also…DR GREGER is also a scientist.  He reads the lit so you don’t have to.  Trust his work.

  3. We recently moved to Florida so we needed a new PCP. My former doctor always pushed Lipitor and made me feel that I was going to drop dead in the next month if I didn’t take it, and I still refused. My new doctor whom I just met today says that Lipitor should not be taken, especially by women. What a great feeling to have a doctor who will work with you to use food to be healthy.

    1. I’m in FL too and my internist specializes in lipids; (I mean, he will truly spend 45 minutes going over your blood work line by line, talking about particles, etc., very intense!) and he just about hugged me when he saw on my chart that I love to cook and grow my own foods. I am quite sure he resists prescribing statins too. Then, there are patients who really are not motivated to eat right–they just want the pill, the *easy* button if you will, very sad. Glad you found a great physician!

  4. Dr. Greger, shouldn’t people with high cholesterol go on statins in the short-term to lower the cholesterol quickly while simultaneously adjusting their diet and increasing physical activity so they can hopefully go off the statins in the long-term?

    By the way, great presentation at the HSUS conference a couple weeks ago.

    1. Matt, I don’t know why, but I don’t think you will get a direct response from a Doctor to this question.  I’ve asked it many times and it is always evaded.  It seems that the link between cholesterol and disease is weak.  but atherosclerosis is rife with oxidized cholesterol…I think the story is yet to unfold.  FWIW, after 7 years on lipitor I bailed for a year. i would rather have the past year off that crap and die sooner  than keep” living” ON it.  It was like a freakin sci fi movie…yoou know, “take your soma komrade”…Good luck. Live happy, gutsy  and long.  Oh right, and prosper.

  5. Is it possible to have too low cholesterol. I’ve been vegan for about 12 years now, so I haven’t eaten any cholesterol for that time.

      1. Coacervate I really loved your life story below. Forks Over Knives should be required watching for all.

        Having too low cholesterol is rare. Could you imagine such an epidemic with the SAD!

  6. I have a dilemma. I am vegan with a family history of high cholesterol. I don’t consume any animal products and yet have high cholesterol. I was put on Simvastatin and am having side effects. Muscle pain.I was wondering if the cholesterol that my body is making is harmful ? My HDL is very good , so do I need a statin ?

    1. Jeanmaclay,
       None of the Doctors replied so i will.  i have the same problem. But i wonder if it is really a problem.  I had a heart triple count em widow maker bypass 8 years ago.  I took all the drugs, got sick as a ****ing dog for 7 years on statin and finally my wife said “if you don’t get off that shit you are as good as dead.”  Bless her profane heart, she strapped me into the lazyboy and force fed me “forks over knives” over and over again…I can name all those folks who got so healthy eating right. “Real men (and women) eat plants!”…well that was a year ago and ,  how can i say this…inside of three weeks of eating whole foods-plant based that creepy angina feeling was GONE.  Whole gross piles of fat and those man-breasts simply vanished… but my cholesterol is 5.9 mMolar…much higher than when i was on lipitor … so why did i have angina on lipitor and not a trace on vegan diet?   I advise you go carefully, take control an see if do better off the drugs than on.  And let your Doctors know they are not very good if they cant see past the drug co’s motives.  Best of luck.  Stay happy!

      1. Coacervate- My cholesterol is lower on the statin, but my hands hurt. Maybe the cholesterol our bodies make is not harmful like the cholesterol that is ingested. It would be nice if there was a study done with vegans with high LDL & HDL to see if there is any long term harm. Congrats on your transformation !

    2. Jean, we’re talking about heart disease the no. 1 killer.  Only YOU can decide if you are going w/ or w/o the statin.  FWIW, all of my 58 year old joints improved, my head cleared and the sleepless nights vanished within 3 days of stopping Simvastatin.  I was taking 80 mg per day.  How much do they have you on? 

      Also, HDL is important but the latest story is about the particle size.  Big LDL good, small LDL bad.  Vegans have Biggest LDL going…but I think this story is evolving and no bout adoubt it, Dr. G will have the latest dope as it accrues.

      Finally, if you google cholesterol vs heart disease or similar search terms then you will find graphs that show a shotgun blast with a straight line through it.  I don’t know why they do that.  It seems that there is no relationship at all. 

      Great photo by the way. 

      1. Coacervate- Ha ha thanks ! 1977 photo. Shorter hair,no cap,hospital scrubs now. Same face due to vegan diet & sunscreen : ).  I  started out on 10 mg Simvastatin and was ok. Got bumped up to 20 and started having pain in my 55 yr old hands. Worse during the night and when I wake up. Body feeling a little achy as well. I know about the LDL particle size and asked my PCP about checking that but she wouldn’t do it even though the phlebotomist in the lab said they can. Must be too expensive. Wonder if I can have it done on my own if I pay for it ? Will have to investigate.I wonder if T. Colin Campbell has any thoughts on this ? I might just have to find out how to contact him as this is an issue that deserves to be investigated. My chiropractor thinks that if my body is producing it, that I must need it. Hope he is right !

  7. Dr. Greger, 
    5 weeks ago we switched our eating to an almost vegan whole foods diet. At first my husband (who had high LDL) felt great, but the last few days he has been feeling poorly… heart burn and chest pressure. Could the sudden extreme change cause this? and how would we find a local doctor who endorses this lifestyle and who could provide closer monitoring?  

    Thanks so much!

  8. Dr. Greger is laid back in this video in large part because He has addressed this issue in other videos. Don’t be deceived. Due to drug companies influence, statins are overprescribed in almost all patients and cholesterol can almost always be reduced with a whole foods plant based diet. Statins have more serious side affects and less benefit than you have been led to believe.

    http://www.youtube.com/watch?v=0F-WBV2yxr0

    http://www.youtube.com/watch?v=AFIJ6lia3UE

    http://www.youtube.com/watch?v=_hbNSHPco0g

  9. Excited by the effects of LDL in my blood after switching to a plant-based diet, I was researching the LDL-lowering impact of statins and stumbled across a forum in which a young woman wrote about her struggles with unusually high cholesterol. I created an account and wrote a short post giving my numbers (including a 34% drop in LDL in just two months), and mentioned your site.

    In 24 hours, my post was deleted and my account barred from forum access.

    I suspect that the website, while claiming to be a “number one source of information for patents and health professionals,” has a financial interest in unhealthy people–either for their own sake, or as a proxy to some larger entity (the pharmaceutical industry, for e.g.).

    Do you hear a lot of reports like this? You talk at length about the good news that is never reported (due to lack of financial motive), but do you see agents (companies?) actively silencing nutrition data?

    1. Hey Michelle, thanks for writing! Many years ago, I read someone answer a question like this by saying that this kind of effect was due to an efflux of cholesterol deposits from the blood vessels back into the blood – NOT a demonstration of ‘de novo’ (new) cholesterol production. I don’t actually know if this is physiologically possible. A more likely scenario is that ‘plant-based’ can include a lot of saturated fat from coconut oil, coconut milk, coconut ice cream, and dairy-free cheeses. ‘Plant-based’ to some also does not totally exclude other foods; many vegetarians eating plant-based diets might be eating a soy burger but putting real cheese on it.

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