The half truths of cholesterol: what divides scientists and confuses citizens

At the end of the seventies, the ideas that sunflower oil was much more appropriate than olive to prevent cardiovascular disorders, that consuming blue fish could erode health and that was Inadvisable to eat more than three eggs a week, recalls Pedro Mata, president of the foundation of Familial Hypercholesterolemia and formerly director of the lipid unit of the Fundación Jiménez Díaz de Madrid. But, since then, new scientific data have emerged suggesting that fats were condemned to purgatory without having had a fair trial, especially after knowing that some American companies related to the sugar industry had Financed scientific studies to put the focus of attention on them, and thus divert it from sweets and sugary beverages. Already said the endocrine and thinker Gregorio Marañón: "There is No part of the medicine more changeable or settled on foundations more bulk than the science of dietetics; It's not a year since I don't change something fundamental. "

Those muds have now brought other sludge. In recent years, a group of researchers has begun to question the existing scientific knowledge about cholesterol and statins (one of the drug groups that help reduce it), which has encouraged various conspiracy theories, being the most Known that physicians who support the use of statins have been bought by the pharmaceutical industry. In turn, some of the drivers of this theory also fall into some suspicions. "It is being said that the sugar industry is behind all this," clears Eduard Baladia, head of the Center for the analysis of scientific evidence of the Spanish Academy of Nutrition and Dietetics. "But the truth is that we handle very consistent data to support that bad cholesterol, OR LDL, has negative effects on the organism. The evidence exists. And there are indications that the dairy industry and the meat industry are moving their threads to convince public opinion that consuming fats is no problem. " The other is the opinion of Dr. Pedro Mata: "The denial of cholesterol is a form of skepticism that leads to pseudoscience. Paradoxically, those who deny their role in coronary disorders promote taking certain substances that they call ' natural ' to reduce it. So, what's the point? Obviously, there is a lot of parallel industry interested in not treating cholesterol with medication, but with parapharmacy. "

There are also cholesterol deniers

The tranquility is brief at home of the Restless, you know, but with what nobody counted is that even two of the most prestigious journals in biomedical research, British medical Journal and The Lancet, were going to occupy opposite trenches in this Showdown. So, while the first has aligned with those who argue that statins are not a Sanalotodo, the Lancet editor, Richard Horton, has come to claim that the damage caused by the critics of cholesterol and drugs to combat it is Being similar to the one that provoked an article published in 1998 that related the vaccines with autism and that ended up unleashing a spectacular decrease of the vaccination in the United Kingdom. And this has happened despite the fact that, subsequently, hundreds of clinical investigations ruled out any link between the formula that generates acquired immunity and developmental disorder; Still in 2019, twenty-one years after that episode, some supporters of alternative medicine, famous characters or leaders of a country like Donald Trump continue to defend this connection.

To be fair, in the case that concerns us it is possible that there is not a single truth, but several complementary truths. Although having elevated levels of certain particles that contain cholesterol in the blood can be dangerous, this lipid is not bad per se. Thanks to it the cell membranes are preserved in good condition and we can synthesize some hormones, like estrogen and testosterone. Also, although the excess of so-called bad cholesterol (LDL) can increase the risk of heart attacks and other fatal cardiovascular diseases, especially when conjugated with other risk factors (smoking, sedentary, hypertension...), the brain It produces its own cholesterol and, within this organ, is essential to keep the neurons healthy (and to protect the memory).

A high level does not represent the same risk for all

"We must individualize each case," announces Dr. Mata. In general terms, it continues, it is desirable that total cholesterol be placed in adults below 200 milligrams per deciliter of blood, while from 240 mg/dl you have to start to take it seriously and go to the doctor. As far as LDL is concerned, below 129 mg/dl The rate is considered to be good, whereas between 160-189 mg/dl is already high, and from 190 mg/dl very high. These reference values, similar to those in other diseases such as hypertension and diabetes, should be analysed on a case-by-case basis by the physician, since it is not the same for a person with high cholesterol without other risk factors (to those mentioned, It adds to be more than 55 years old, to eat many ultraprocessed products and to have suffered a cardiovascular episode) that another one that gathers them all; And, on the contrary, there are individuals with high coronary risk despite maintaining a good level of cholesterol. "This debate reminds me of when Winston Churchill was said to have smoked all his life and died at 90 years, probably because he had some genetic conditioning of personal protection, but this is not the general rule," warns Mata.

What you eat is important, but not because of your cholesterol

Cholesterol containing some foods does not influence as much as was thought 40 years ago in the increase in total plasma (it is estimated that only between 15% and 20% of blood cholesterol comes from feeding and that the body synthesizes between 80% and 85% r Shelf). "In general, it matters more not to consume partially hydrogenated fats, the main dietary source of trans fats, and sugar (instead of saturated fats, which were considered so far the main culprits of all our ills), "clarifies Oihana monastery, member of the group of specialization in clinical nutrition of the Spanish Academy of Nutrition and Dietetics. To the first group, to that of the hydrogenated ones, belong some vegetal oils like that of coconut and that of palm, rich in stearic acid and palmitic, respectively, very used in the industrial bakery and in the elaboration of processed foods.

Demonizing fats has resulted in many people having given up consuming them to opt for simple carbohydrates (found in fruit, milk and derivatives, but also in sugar and refined candies). That's why we can distinguish between those who are healthy and those who are not. Clarified the case of lipids, it's up to carbohydrates or carbohydrates. What happens to them, laments Mata, "is that the whole fruit is no longer taken, but in juice [its sugar is considered free sugar, whose metabolic effect is different from that of the whole fruit]; And instead of whole grains, pastries are preferred; And, of course, refined sugars have a detrimental effect because we take many without noticing and ultimately inhibit insulin sensitivity. " With an added problem: "foods rich in refined carbohydrates are also in trans fatty acids". Thus, the best strategy to circumvent cholesterol through food is to prioritize foods with better profile of the three existing macronutrients – carbohydrates, fats and proteins – and avoid the worst: refined (in the first case), Fats Trans and the proteins that supply processed meats and sausages.

Around with the eggs: How about a omelette a day?

In the face of the ancient dogma that the cholesterol of the egg is almost a passport to the INFARCT, today a new scientific truth looms out of the shell: any healthy person can safely eat a daily egg. And there is no reason to throw your hands to your head: Unlike many pseudoterapias who continue to hold the same postulates for hundreds of years without changing a single comma of their discourse, existing scientific knowledge is periodically renewed to The light of every evidence that is discovered, and the case of eggs is an example of a book. In fact, the study that put them back on suspicion last March, published by the journal JAMA, became weak after a thorough analysis, such as that made by the dietitian-nutritionist Julio BASULTO FOR the country: "There is correlation but not causality Between egg consumption and mortality. And even this is not very strong. "

Today it is advisable to replace the red meat with food protein, but with a healthier profile, such as eggs, fish or legumes. Pedro Mata insists that it is possible to choose between a yolk or two clears a day. Yes, if the person suffers familial hypercholesterolemia, hereditary disease that is expressed from birth and that affects in Spain about 190,000 people, the recommended consumption is four eggs a week, at most.

The refrigerator has no substitute for the drug or sport

The guide of Clinical Practice on the management of lipids as a cardiovascular risk factor, published by the Ministry of Health, does not recommend using Phytosterols supplements in the Prevention of cardiovascular disease (plants do not manufacture Cholesterol, but these chemicals whose structure is similar; And the higher the quantity, the more sterols or the lower the cholesterol the organism absorbs. In the words of Basulto, "It is not clear that this cholesterol reduction has a significant clinical relevance in cardiovascular health, as there are no sufficiently well designed studies to highlight it." On this particular, the dietitian-nutritionist Baladia explains that, sometimes, the alleged benefits that some people experience when consumed in yoghurts, margarines and biscuits with groups that do not take them, "when it would be logical to ponder Its efficacy in relation to the reference drug to combat elevated cholesterol, statins, "he stresses.

That is, if a person has very high cholesterol (in addition to other factors of coronary risk) it is advisable, as an urgency, is to take statins (or other similar medication), considering that, according to existing scientific knowledge, It is the best pharmacological remedy to block, decrease or moderate the production of cholesterol. However, if the situation is not compelling, it is most appropriate to introduce lifestyle changes (such as practicing physical activity, quitting smoking, lowering the consumption of processed products...), and not trying to put a patch in the form of yogurt or biscuit.

With so many statins, why are there fewer heart attacks?

This is one of the star questions posed by the documentary cholesterol, the great deception, a French production of 2016 directed by Anne Georget. As shown in a graph of 2004, hospitalizations for individuals by heart attack in the United Kingdom have remained stable despite having prescribed statins to thousands of British since 1996. This leads to the French cardiologist and researcher Michel de Lorgeril (whose books, eye, questions the vaccine system and argues that drinking alcohol in a moderate way has a protective effect on health, which is not accurate), to conclude the following at a time of Film: "Obviously, if statins were effective in the prevention of heart attack, we would have seen a decrease in hospitalizations for heart attack..., and that is not what happens."

The explanation of the graph that the cholesterol deniers wields may be easier than it seems: if thousands of people had not started treating statins since the last decade OF the twentieth century, the mortality curve Cardiovascular would not have remained stable, – points out Dr. Mata –, but would have tended to increase clearly due to the unstoppable increase in overweight rates that are recorded in the UK since 1995 (in the year 2007 the British were already the most obese of Europe because of the high consumption of alcohol and not eating just fruits or vegetables) and a higher prevalence of diabetes and hypertension, among other pathologies.

Baladia points to another possible cause. "It is also said that there is a correlation between the number of drownings occurring in the United States and the numbers of films shot by Nicolas Cage. But it turns out that they are two curves of the same population placed one on top of the other. This happens the same way. Simply, the people to whom mortality is kept flat is not the same as the one taking statins. When these are prescribed to risk subjects, patients die less, "the expert judge. Because, being true that they are a drug that is too much prescribed, as emphasizes the nutritionist of the nutrition unit of the Hospital of Basurto (Bilbao) Oihana Monastery, much of the scientific community considers that its effectiveness is amply Tested.

Without going further, in 2017, a review published In The Lancet estimated that these treatments prevent about 80,000 strokes and stroke each year. On its undesirable effects, there is evidence that they may cause muscle aches, but not in the alarming proportions that the cholesterol skeptics point out. As Rory Collins, professor of the clinical Trial Services unit at Oxford University, said in an article in the Guardian, "The vast majority of its side effects can be reversed if treatment is suspended, but attacks Cardiac causes permanent damage. "

And this looks great to keep changing...

Although there are countless investigations with discordant results, there is something that is not given to discussion: the presence of high levels of bad cholesterol in the blood increases the risk of cardiovascular disease. Of the total, few remember: it is known that the relevant thing is to talk about the two lipoproteins that transport them, the mentioned LDL (the bad) and the HDL (the good). But what if we were leaving something on the road? Some researchers argue that THE LDL level should be substituted (or supplemented) by Apolipoprotein B (ApoB), a protein that acts as a carrier of bad cholesterol. However, this does not negate the underlying truth: until proven otherwise, high cholesterol is a problem.

Last March, a new work was presented in the Journal of the American College of Cardiology, which identified a molecule that quadruples the risk of cardiovascular disease. The actor itself is a protein attached to a LDL particle that has an inflammatory effect of the arterial wall and accelerates atherosclerosis and thrombosis. There is no doubt: triggered levels of this lipid increase the risk of cardiovascular disease, the leading cause of death in the world, even for those who insist on denying it.