En till artikel om kolesterol, Björn Hammarskjöld, m fl.

http://kostkunskap.blogg.se/2016/june/sluta-at-statiner.html

Sluta ät statiner

Nu har den äntligen kommit. Artikeln som slår undan fötterna för kolesterolmaffian.

Lack of an association or an inverse association between low-densitylipoprotein cholesterol and mortality in the elderly: a systematic review

Uffe Ravnskov, David M Diamond, Rokura Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Aseem Malhotra, Luca Mascitelli, Kilmer S McCully, Yoichi Ogushi, Harumi Okuyama, Paul J Rosch, Tore Schersten, Sherif Sultan, Ralf Sundberg

http://bmjopen.bmj.com/content/6/6/e010401.full.pdf+html

Det är 17 vetenskapsmän som tillsammans har gått igenom ett stort antal artiklar och funnit 19 studier som jämför det ”onda” LDL-kolesterolvärdet och död. Det blev 68 094 äldre där man registrerade alla dödsfall i 28 grupper och hjärt-kärldöd i 9 grupper.

Det visar sig att man fann en negativ korrelation mellan död av alla orsaker och LDL-kolesterol i 16 grupper varav 14 var statistiskt signifikant skillnad. Det var 92 av alla där man registrerade sambandet. Bland övriga kunde man inte finna någon association.

I två grupper vad dödligheten högst bland dem som hade lägsta LDL-kolestrolhalten. Bland sju grupper fanns ingen association.

Slutsatsen blev att ju lägre LDL-kolesterol desto högre var risken att dö bland dem som var äldre än 60 år.

Denna upptäckt är tvärtemot kolesterolhypotesen där LDL-koleterol ger kärlförfettning och död.

Detta visar att äldre personer med högt LDL-kolesterol lever längre än personermed lågt LDL-kolesterol.

Vidare måste nu rekommendationerna rörande farmakologisk minskning av LDL-kolesterol för att minska hjärt-kärlsjukdomar ifrågasättas hos patienter äldre än 60 år.

Läs hela artikeln här:http://bmjopen.bmj.com/content/6/6/e010401.full.pdf+html

Min konklusion:
Nu har det visats att inte bara det ”goda” HDL-kolesterol ska vara högt för att ge ett klart förlängt liv utan även det ”onda” LDL-kolesterolet bör vara högt för ett långt liv.

Då behöver ingen över 60 års ålder äta kolesterolsänkande statiner. Med tanke på att omkring 34,4 % av alla svenska invånare över 60 år står på statiner var det 733 239 personer över 60 års ålder som 2015 stod på statiner. Källa: Socialstyrelsens läkemedelsstatistik 2016-06-14

Ingen av dessa 733 239 personer över 60 års ålder behöver äta statiner. Alla dessa patienter har fått biverkningar av statinerna. Källa: Socialstyrelsens läkemedelsstatistik 2016-06-14

Som följd av att de över 60 års ålder nu slipper statiner saknas anledning att särbehandla personer under 60 års ålder.

Ingen av de 168 322 personer som är under 60 års ålder behöver äta statiner. Alla dessa patienter har fått biverkningar av statinerna. Källa: Socialstyrelsens läkemedelsstatistik 2016-06-14

Ingen av alla dessa 901 561personer i alla åldrar behöver äta statiner. Alla dessa patienter har fått biverkningar av statinerna.

Biverkningarna är många och allvarliga. Alla får en försämring av hjärnans funktion då nervsignalmolekylerna inte kan skickas mellan nervtrådar på grund av kolesterolbrist. En del får en klar demensutveckling på grund av statinerna. Enstaka (i realiteten hundratals) patienter får total minnesförlust.
Muskelvärk är vanligt, man orkar inte gå ens på grund av energibrist i cellerna. Sexlivet blir lidande, risken för sockersjuka ökar och de som redan har sockersjuka får ökat P-glukos eftersom insulintransporten minskar på grund av kolesterolbrist.

Om jag stode på statiner skulle jag låta bli att ta mer statiner och ta med mig artikeln i BMJ Open till min läkare och få denne att slut skriva ut statiner. Kallas patientmakt och har stöd i Patientsäkerhetslagens 6 kapitel 1 §.

Björn Hammarskjöld
En av författarna i BMJ-artikeln
Assisterande professor
F.d. överläkare i pediatrik
Filosofie licentiat i biokemi

Article – Diabetes and diet: There’s an epidemic of misinformation

http://www.hsj.co.uk/5089797.article#.VdiSdXjGuT9
21 August, 2015 | By 

As the NHS struggles with rising cases of diabetes, it is time to examine the role of diet and lifestyle in tackling this challenge. The so called benefits of medical interventions detracts from more beneficial lifestyle changes, says Dr Aseem Malhotra

Early this year, Karen Thomson, the granddaughter of pioneering heart transplant surgeon Christiaan Barnard, organised world’s first low carb summit in South Africa and invited me as a speaker.

The four day conference was co-hosted by leading professor of exercise and sports medicine Timothy Noakes, and there was no food industry or pharmaceutical industry funding.  There were a total of 15 international speakers including academic researchers and medical doctors and was an eloquent and evidence based demolition job of current dietary guidelines that promotes “low fat” as best for weight and health.

Award winning author of Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health Gary Taubes opened the conference explaining that obesity is not so much a disease of energy imbalance but one of fat accumulation caused by excess insulin, driven primarily by carbohydrate consumption.

‘You don’t get fat from eating fatty foods just as you don’t turn green from eating green vegetables’

Swedish family doctor Andreas Eenfeldt, who runs Diet Doctor, the country’s most popular health blog, discussed the beginning of a decline in the rate of obesity in Sweden where it is estimated that up to a quarter of the population are embracing low carb diet and the sales of butter have rocketed in the past few years.

“You don’t get fat from eating fatty foods just as you don’t turn green from eating green vegetables,” he said in response to a two year review of 16,000 studies carried out by the Swedish Council on Health Technology.

It concluded that such a diet may not only be the best for weight loss but also at reducing several markers of cardiovascular risk in the obese. And he’s right.

Fat calories which have the least impact on insulin secretion promote satiation and energy utilisation whereas refined carbohydrates in particular promote fat storage and hunger.

A public health message to lower cholesterol as if this was the end in itself may have also been counter-productive.

More powerful than aspirin

Not many people know that during the first 14 years of the Framingham heart study – a long term, ongoing cardiovascular study on residents of the town in Massachusetts – which sanctified high cholesterol as a major risk factor for heart disease for every 1mg/dl per year drop in cholesterol levels, there was a 14 per cent increase in cardiovascular death and an 11 per cent increase in mortality in the following 18 years in those aged over 50.

The Honolulu heart study published in the Lancet in 2001 revealed that in those aged over 70, a high total cholesterol was inversely associated with risk of death.

A re-analysis of unpublished data in the Sydney heart study also revealed that cardiac patients that replaced butter with omega 6 containing safflower oil margarine had an increased mortality despite a 13 per cent reduction in total cholesterol.

As professor of cardiology at the University of California, Rita Redberg says: “Cholesterol’s just a lab number. Who cares about lowering cholesterol unless it actually translates into a benefit to patients?”

In comparison to the American Heart Association’s recommended “low fat” diet, adopting a Mediterranean diet after a heart attack is a more powerful life saving tool than taking aspirin, statins, or coronary stents. But makes little significant difference in total cholesterol, triglycerides or high-density lipoprotein between the two groups. The polyphenols and omega 3 fatty acids abundant in olive oil, nuts, vegetables and fatty fish are responsible for rapidly reducing  thrombosis and inflammation.

‘Policy makers fail to acknowledge there are many different types of saturated fat with varying effects’

What many scientists, doctors, media writers and policy makers fail to acknowledge is that there are many different types of saturated fat with varying biological effects.

Two recent Medical Research Council Cambridge studies concluded that the consumption of dairy saturated fats found in yoghurt and cheese were inversely associated with the development of cardiovascular disease and type 2 diabetes, whereas endogenously synthesised plasma saturated fatty acids that correlate with an increased risk are driven by the consumption of starch, sugar and alcohol.

In the closing talk of the convention Professor Noakes delivered a humble, yet devastating response to some critics who have described his bestselling book, The Real Meal Revolution, as dangerous.

But what makes Noakes, a man who has over 400 scientific publications, most remarkable is the U-turn in the very dietary advice he himself promulgated for most of his illustrious career: endurance athletes need to load up on carbs to enhance performance.

Maybe more academics should consider the words of Stephen Hawking, who proudly disproved his own theories on the existence of black holes: “People are very reluctant to give up a theory in which they have invested a lot of time and effort.

“They usually start by questioning the accuracy of the observations. If that fails they try to modify the theory in an ad hoc manner. Eventually the theory becomes a creaking and ugly edifice.”

Misguided on sugar

Earlier this week Diabetes UK rightly raised concerns over a significant rise in the cases of type 2 diabetes in the past decade and called on the NHS to improve care for patients and concentrate on greater efforts for prevention.

Although aggressive glucose control can marginally reduce the risk of microvascular complications, earlier detection through routine screening or medical treatment does not have any impact on reducing cardiovascular disease outcomes or improves all cause mortality.

A recent critical review in Nutrition concludes that dietary carbohydrate restriction is the “single most effective intervention for reducing all of the features of the metabolic syndrome”. It should be the first approach in diabetes management with a diet that comprises less than 10 per cent of calorie intake from carbohydrates. It also reveals the greatest falls in HbA1C and reduction in the use of medications with benefits also occurs, even without weight loss.

But how many patients are explicitly given this information?

‘There’s an epidemic of misinformed doctors and patients’

And given that type 2 diabetes is a condition related to an intolerance to metabolise carbohydrates, it is puzzling why Diabetes UK recommends as part of a “healthy balanced diet” the consumption of plenty of starchy carbohydrates and modest amounts of sugary food and drinks including cakes and biscuits.

It is therefore not surprising that the public have such misguided perceptions. Even many doctors’ understanding of nutrition comes from TV and magazines.

Biased funding of research, biased reporting in the media and commercial conflicts of interest have resulted in an epidemic of misinformed doctors and misinformed patients where an exaggeration of the benefits of medical interventions has simultaneously detracted from more impactful lifestyle changes.

If we are to truly maintain the sustainability of the NHS, clinicians need to take a broader population perspective so that responsibilities extend beyond the patient admitted to hospital but also to have a responsibility to the health of their local population.

To reflect on the words of the late Mr Barnard: “I have saved the lives of 150 people through heart transplantations. If I had focused on preventative medicine earlier, I would have saved 150 million.”

Dr Aseem Malhotra is a London based cardiologist and adviser to the National Obesity Forum

August 2019
M T W T F S S
« May    
 1234
567891011
12131415161718
19202122232425
262728293031