The Statin/Cholesterol Business Model
FEATURE
PERSPECTIVE
David Seaman
DC
Implications for your practice
The most common side effect of taking statin medications is muscle pain. This will certainly impact one’s practice, as over 35 million Americans currently take statins to reduce cholesterol, which makes them one of the most commonly prescribed medications. To put this into perspective, we need to consider that 60% of Americans are 30 years and older, which amounts to about 200 million people. This means that almost 18% of the adult population currently takes statins.
While the potential impact of statin use in relation to muscle pain is generally well known, most people are unaware that the proinflammatory hypercholesterolemia state is a known driver of tendinopathy, osteoarthritis, and disc herniation.1'3 This makes normalizing blood lipids an important promoter of musculoskeletal health. Not surprisingly, lifestyle modifications represent the best way to normalize blood lipids, which will be discussed in the final section of this article.
Statin Treatment Recommendations
In 2018, the American Heart Association (AHA) came out with a new Cholesterol Management Guide for Health Care Practitioners, which is freely downloadable as a PDF document.4 It states that there is no known “ideal” blood level for LDL cholesterol (LDL-C). Their operational goal is for people to have a total cholesterol below 150 mg/dL, with LDL-C at or below 100 mg/dL.
The 2018 AHA cholesterol management guide provides a list of risk enhancers that should guide statin prescribing, such as family history of cardiovascular disease, chronic kidney disease, metabolic syndrome, autoimmune disease, and premature menopause. A C-reactive protein level above 2 mg/L is also considered a risk enhancer. If risk enhancers are present, then even people with LDL-C at 75 mg/dL are considered candidates for statin therapy. In short, the 2018 AHA cholesterol management guide indicates that 48.6% of adult Americans over 40 are candidates for a statin prescription.
Such a level of prescription of statin represents substantial profits for the statin industry. In fact, by 2020, it is estimated that worldwide sales of statins will reach $ 1 trillion.5 For perspective, $1 trillion is one thousand billion dollars of revenue. If everyone committed to normalizing their blood lipids, this would represent a substantial loss of money for the statin industry. One should make no mistake in viewing cholesterol as a serious health issue; it is far more a statin business model than anything else. This becomes more apparent when one realizes that there are elements of cholesterol metabolism that are virtually unknown by physicians and patients alike.
How to normalize cholesterol naturally
For decades, doctors and their patients have been conditioned to fear cholesterol. In natural medicine, doctors look for supplements to lower cholesterol. In medicine, they try to “drug it down” to as low a level as possible. Ironically, even when I was pursuing my MS in nutrition in the late 1980s, the instructor who taught the cardiovascular nutrition class was most excited to teach us about medications. It will become obvious throughout the remainder of this article that using supplements or drugs to try to lower cholesterol is mostly a foolish long-term endeavor.
In short, almost everyone believes that LDL cholesterol is bad and HDL cholesterol is good. One should understand that this is a limited view of cholesterol that the medical establishment promotes and aggressively transmits to patients. Consider a question that few people seem to ask: If LDL cholesterol is so bad and disease-promoting, then why does the liver normally produce 2-3 times more LDL than HDL cholesterol?
If the “LDL is bad” mantra is true, it would actually suggest that our livers are trying to kill us, which is a preposterous notion. In fact, there is no evidence that normal LDL cholesterol is pathogenic. It first has to be modified and free radicalized before it can promote heart disease6 or musculoskeletal pathologies.1'3
Normal LDL is large, soft, and buoyant, and has absolutely no pathogenic potential. In contrast, disease-promoting LDL is small, dense, and free radicalized, which means that it is inflamed. This inflamed LDL particle acts as an antigen to stimulate the immune system to drive chronic inflammation in cardiovascular and musculoskeletal tissues.6
People with the metabolic syndrome suffer from chronic inflammation, which, in part, manifests as inflamed LDL cholesterol and inflamed HDL cholesterol.6 In essence, cholesterol metabolism becomes inflamed in patients with the metabolic syndrome; there are increased levels of LDL cholesterol and reduced levels of HDL cholesterol, and both LDL and HDL become inflamed.
The medical industrial complex is solely focused on elevated LDL cholesterol, which also manifests as an elevated total cholesterol level. What patients, and most physicians, do not realize is that it is hyperinsulinemia that is the cause of hypercholesterolemia. This is why patients with the metabolic syndrome and type 2 diabetes have elevated LDL and total cholesterol levels.6
It turns out that insulin stimulates an enzyme called HMG-CoA reductase, which is the key rate-limiting enzyme in cholesterol production. Statin drugs are also called HMGCoA reductase inhibitors, which means that statins function to inhibit the enzyme that is activated by hyperinsulinemia.6 This means that if patients work to reverse the metabolic syndrome and diabetes, which is easy to do, they will turn off the drive to overproduce LDL cholesterol. If patients were properly instructed and motivated to do this6, one could imagine how this would compromise the statin/cholesterol business model. There would be minimal to no need for statins and the various medications that deal with hyperglycemia and hyperinsulinemia. The loss of revenue would be massive for the producers of these medications.
Considering the aforementioned information, it is clear that keeping patients and physicians in the dark about cholesterol metabolism is good business for the producers of statins. The ultimate problem for patients is that not only do they live in a perpetually inflamed state, which can damage muscles, joints, tendons, and discs, but they can also suffer the many side effects associated with statin use.
References
1. Scott A, et al. Lipids, adiposity and tendinopathy: is there a mechanistic link? Critical review. Br J Sports Med. 2015;49:984-88.
2. Farnaghi S, et al. Cholesterol metabolism in the pathogenesis of osteoarthritis. International J Rheum Dis. 2017;20:131-140.
3. Li X, et al. Possible involvement of the oxLDL LOX-1 system in the pathogenesis and progression of human intervertebral disc degeneration or herniation. Sci Rep. 2017:7:7403
4. American Heart Association. Cholesterol Management Guide for Health Care Practitioners. 2018. https: www. heart, org - media files health-topics cholesterol chlstrmngmntgd 181110.pdf
5. Demasi M. Statin wars: have we been misled about the evidence? A narrative review. Brit J Sports Med. 2018;52:905-909.
6. Seaman DR. The DeFlame Diet. Wilmington, NC: Shadow Panther Press; 2016.
Dr. Seaman is consultant for Anabolic Laboratories and has designed several nutritional supplements. He has authored many articles on the topic of diet, inflammation, and pain. His most recent book written for laypeople is entitled The DeFlame Diet. He posts regular DeFlame nutrition updates at DeFlame Nutrition on YouTube and Facebook.
