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INFLAMMATION NOT LDL

Lawrenceville, NJ (Dr Simone) – I have long maintained that it is not the level of cholesterol that increases the risk for cardiovascular disease, cancer, other chronic illnesses and poor athletic performance, but rather it is the inflammation and oxidation from those cholesterol containing foods. 

At a medical conference I asked a Chairman of Medicine of a prestigious university how he would treat a man who had a massive heart attack with a cholesterol of only 140, LDL of 50 and no other risk factors.  He said ‘That’s a no brainer – give him a high dose statin.’  I then said, “That man’s cholesterol and LDL are excellent.  It’s probably only inflammation or a clot, so one could use vitamins and other nutrients instead.”  He abruptly and arrogantly said ‘No, give him a statin’ and he turned away.  This is what Big Pharma does.  They pay so-called “thought leaders” to influence other doctors to prescribe their drugs. And these “thought leaders” must not deviate from the written words given to them by Big Pharma.

You can see how much any doctor or hospital are paid by Big Pharma on Pro-Publica, an investigative reporting group. You will be surprised at the amount paid by Big Pharma to some doctors and to some major hospitals

https://projects.propublica.org/docdollars/

Arteries are composed of living cells.  Inflammation initiates the artery lesion by making the adhesion molecule VCAM-1.  This attracts white blood cells called monocytes and T-cells that engulf lipids, thus forming the fatty streak progressing to plaque.  Narrowing arteries do not necessarily cause a heart attack and treating those narrowed arteries with stents or bypass surgery does not prolong life. 

There are multiple lines of evidence that inflammation increases the risk for cardiovascular disease, cancer and other chronic illnesses:

1) I have written that the LDL cholesterol contributed only modestly to overall risk (Lancet August 2014) because people who had the most reduction in inflammation, not LDL, had the least recurrent vascular events.  And that’s why a committee of a mere 15 people changed the US guidelines from treating to a specific LDL target to arbitrarily and capriciously treating patients who were at high risk with high dose statin.

DO YOU KNOW YOUR LDL? HDL? TRIGLYCERIDES? ARE THEY IMPORTANT?

2) Genetics of LDL.  Is the benefit of statin therapy from lowering lipids or decreasing inflammation?  The genetic loci that relate to statin induced LDL reductions are distinct from the genetic loci that are associated with statin induced reductions of inflammation.  People who had the most reduction in inflammation had the least recurrent vascular events.  People who had low LDL and ordinarily would not require statin treatment but who were treated with statins anyway, had reduced heart attacks, strokes, and all-cause mortality. 

3) Another line of evidence shows that lowering LDL to very low levels using an antibody (evolocumab) did not extend life and in fact there were more deaths in the treatment group. 

LOW LDL DOES NOT PROTECT, BUT BIG PHARMA AND HARVARD SAY YES  

4) CANTOS Trialpatients were given a monoclonal antibody (canakinumab) to lower a protein in their bodies that causes inflammation, interleukin-1Beta.  This antibody reduced inflammation and reduced cardiovascular events, including stroke, without lowering cholesterol or LDL-cholesterol (1).  The patients taking this antibody had a higher incidence of fatal infection and there was no significant difference in mortality.  In addition, the prohibitive cost is $200,000 a year.  The conclusion though is important: Decreasing inflammation will decrease risk of cardiovascular events without lowering cholesterol or LDL-cholesterol.  In addition, those patients who received the highest dose of this antibody had a 51% lower cancer mortality and a 77% lower lung mortality (2).

Other inflammatory diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel disease have a high risk for cardiovascular disease.  Those patients receive antiinflammatory treatments and have a decrease risk of cardiovascular disease and cardiovascular events (3,4).  Based on this information, the National Institutes of Health is currently investigating the use of low-dose methotrexate to reduce inflammation and thereby decrease the incidence of cardiac events for those who had a heart attack and have diabetes or metabolic syndrome.

Dr Simone Recommendation

IT’S ALL ABOUT INFLAMMATION AND OXIDATION.    Lipids are markers of foods that increase inflammation and oxidation.  So if you take prescription medications or nutrients to lower your lipids but continue eating high fat, high sugar, low fiber foods, you will continue to cause inflammation and oxidation in your body.  Other controllable risk factors like overweight / obesity, smoking, alcohol, etc, also increase inflammation and oxidation. 

 

INFLAMMATION AND OXIDATION – WHAT YOU CAN DO

You should consider taking antioxidants in the correct doses, correct chemical forms, and correct ratios of one to another.  Also take anti-inflammatory agents. 

 

Anti-Inflammatory Foods

  • Green leafy veggies such as spinach, kale, and collards.

  • Fruits and vegetables that have color like blueberries, pineapples, strawberries, cherries, and oranges. Quercetin is found in these and is an antioxidant and anti-inflammatory agent. 

  • Walnuts and fatty fish have high amounts of omega 3 fatty acids: wild-caught salmon, mackerel, tuna, and sardines.

Supplements to reduce inflammation

  • Alpha-Lipoic Acid

  • Curcumin is a component of the spice Turmeric.

  • Omega 3 fatty acids 

  • Ginger

  • Resveratrol

  • Cayenne

  • Cinnamon

  • Cloves

  • Sage

  • Rosemary

References

1.  Ridker et al, N Engl J Med 2017; 377:1119-1131  http://www.nejm.org/doi/full/10.1056/NEJMoa1707914

2. Ridker et al. 2018. Lancet. 391:319-328.  https://www.ncbi.nlm.nih.gov/pubmed/29146124

3. Hjuler et al. JAMA Dermatol 2016. 152:1114-21

4. Wu JJ et al. J Am Acad Dermatol. 2017. 76:81-90

(c) 2018 Charles B Simone, M.MS., M.D.