What if we could prevent strokes? - Low-Carb High-Fat...

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What if we could prevent strokes?

TheAwfulToad profile image
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Strokes are probably more feared than heart attacks, because a serious one can rob you of your most valued faculties: your mind or your mobility. Because of what they do to the patient, they also represent a costly burden on the heath service. Wouldn't it be nice if we knew what caused them?

It turns out that we do ... sort of. Or at least we have some tantalising pointers that hint at what NOT to do if we want to minimize strokes.

The Lothian Birth Cohort studies (there are two) were originally a slightly sinister attempt to map out the intelligence (or lack of it) in Scottish children during the 30s and 40s. The data were repurposed, and the subjects traced, to investigate how cognitive function changes with age. Almost as an afterthought, researchers have also correlated cholesterol markers for cancer, CVD and stroke.

Buried in this thesis, compiled by a true believer in the diet-heart hypothesis, is a set of figures that ought to register as a seismic event in medical history:

pdfs.semanticscholar.org/b3...

The important paper here starts on p161. Refer to the chart on p165, which shows total cholesterol correlating with various age-related diseases: stroke, CVD, and hypertension.

Have a look at the 'stroke' row, in which older people with low cholesterol have had a whopping 40% incidence of stroke, whereas those with "high" cholesterol (ie., normal, unmodified cholesterol) have had a 1% incidence. 1% incidence is about as close as you get in real life to zero: by way of comparison, the lifetime risk of a non-smoker getting lung cancer is about 5%. The CVD line is not quite as impressive, but still pretty dramatic: about 15% incidence in the mid/high TC groups, compared to 40% in the low TC group.

Now, the current bar for having 'high cholesterol', and being put on statins, is 5mmol/L - that is, at the dividing line between the 'low' and 'mid' groups in this chart. Note that many of those with cholesterol lower than 5mmol/L are in fact taking statins. Since statins very reliably reduce total cholesterol, we can infer that they have low cholesterol because they are taking statins. We can further infer that, if you don't take statins, your normal TC hovers somewhere around 6mmol/L, plus or minus, at age 70.

The author remarks, without any apparent sense of irony, that:

"In the current sample, the low-TC group had the highest prevalence not only of CVD but stroke, hypertension, statin use, and high BMI, and therefore the most likely group to have made dietary modifications as part of a health management program to reduce weight and improve overall health."

Translation: following the standard health advice, and taking statins, might be making you fat and ill. My goodness. It's another of those paradoxes!

You'd think somebody would have picked up on this paper, but it's actually quite hard to find. It's buried there in Dr Corley's PhD thesis, and in the five years since publication has been cited only a dozen times or so, as far as I can figure out. Yet here we apparently have a population of older people who do not get strokes ... and bear in mind that 'stroke' describes at least two distinct disease processes. Isn't this important? Shouldn't the NHS be taking note? Should they not, at least, reconsider the policy of handing out statins to 70-year-olds in view of that 40% incidence of strokes in a group with low cholesterol, and a minimum background level of strokes in the other groups?

I suppose the statin cheerleaders will say: "Ah but. You're looking at a single data point here. Perhaps those people in the low-cholesterol group may have been at high risk for other reasons, and would have all been dead by now if we hadn't prescribed them statins. 40% incidence is better than 100% incidence".

Well, maybe so. Except that the theoretical premise for taking statins is that high cholesterol leads to strokes and CVD, so if that defence is true, it suggests that the protective effect of statins (assuming it exists) has nothing to do with cholesterol reduction. More research, as they say, is needed. But since the response to this paper from the research community has been a big ol' ball of tumbleweed bouncing gently around the campuses, I'm not holding my breath.

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Now you have me in a tizz! Under active thyroid so high cholesterol, AF so high risk of stroke. Chadvasc score of 4! On statins!!

Di

TheAwfulToad profile image
TheAwfulToadAmbassador in reply to

Well ... AF is an established cause of strokes, with a well-understood mechanism, so whole different ball game there. But you might want to ask your doctor why you're on statins, and chase that "why?" beyond the first answer ("because you have high cholesterol"). The ultimate answer will be something along the lines of "Because the government wants you to have low cholesterol, and The Men With Clipboards will cause trouble for our practice if we don't prescribe statins".

ChubbieChops profile image
ChubbieChops in reply to

What is AF?

in reply toChubbieChops

Atrial Fibrillation. Your beats out of sync and you are 5 times more likely to suffer a stroke xx

ChubbieChops profile image
ChubbieChops in reply to

Ah right, thank you

ChubbieChops profile image
ChubbieChops

I thought I'd have a look at the thesis you referred to above - at 248 pages, maybe not!! Thank you for the summary. How did you come across this?

TheAwfulToad profile image
TheAwfulToadAmbassador in reply toChubbieChops

It wasn't easy to find! It's something I've been looking for since it was mentioned in a video posted by Praveen55 a few months back. The presenter quoted those stats and I thought "Wait, what? That can't possibly be right. Surely he's just making this stuff up". I mean, I believe LCHF is inherently healthy, and better for your heart than "low fat", but I don't take things that look too good to be true at face value.

So I went looking for the original paper. I couldn't find it, which was odd, because earth-shattering papers usually end up being put out there for free. Eventually I found it behind a paywall, but I didn't want to pay 25 quid for it. After a bit more googling I eventually found that PhD thesis, which includes all of the author's other publications alongside the paper I wanted.

When I saw the raw data I was just blown away. The presenter in the video wasn't making it up. People with high cholesterol literally do not get strokes, apart from the occasional bad-luck event.

When you see a difference of that magnitude, you can be pretty sure you're looking at cause-and-effect (as opposed to coincidental correlation). At best, it's an indication that people with "high cholesterol" are simply not at risk of strokes, which completely contradicts the official position. It means there is no clinical justification for cholesterol-lowering medication. At worst, the numbers strongly suggest that statins are directly responsible for that massive increase in strokes in the low-cholesterol group. Why? Because about half the people in the low-cholesterol group are taking statins, while the high cholesterol group seem to be deliberately avoiding them. Tantalizingly the numbers aren't broken down further - it would be interesting to know if the 40% of people who experience strokes are the same 40% on statins! I'm just baffled that the researchers didn't even bother to check that.

ChubbieChops profile image
ChubbieChops in reply toTheAwfulToad

I am just tidying up my letter of criticism to the NHS. I found another article which is challenging to understand, partly because it is long and quite scientificy and partly because it does turn the current perceived wisdom on its head. If you're interested...

westonaprice.org/health-top...

MTCee profile image
MTCee

The people who make lots of money from statins are going to start hunting you down Toad 😉

jerry12953 profile image
jerry12953

Very interesting. Thanks.

My cholesterol levels have been "borderline" for a long time, so when I started to get angina the drs. had another attempt to get me on statins and this time I reluctantly agreed. I'd like to stop; are there any other causes of strokes which are not related to cholesterol?

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