By Simeon Margolis, M.D., Ph.D. Provided by: Johns Hopkins University

Behind the Headlines

Is Cholesterol the Ultimate Villain? Posted Thu, Jul 03, 2008, 3:54 pm PDT

71% of users found this article helpful.
I just came across a good example of a disbeliever: William Campbell Douglass II, M.D., who publishes The Douglas Report only a few miles from my office here at Johns Hopkins Hospital. In his publication, Douglas refers to himself as "medicine's most notorious myth-buster."

His Report states "Forget the myths about cholesterol and animal fat. And forget all of those cholesterol-lowering drugs."

To support his claim that the risk posed by dietary cholesterol and saturated fat is a myth, Douglas cites one study which demonstrated that a very low-fat diet lowered blood levels of protective ("good") HDL cholesterol. But he fails to mention any of the numerous dietary studies showing that cholesterol in the diet, and especially saturated fat, raise levels of the atherogenic LDL ("bad") cholesterol.

Instead of cholesterol, Douglass targets the amino acid homocysteine as the real culprit behind the development of atherosclerosis. He goes on to accurately cite several careful studies that do link slightly high levels of homocysteine with a higher risk of heart attacks and strokes.

But then he states that vitamins B6, B12, and folic acid are the keys to maintaining normal homocysteine levels and thus are crucial to maintaining better vascular health. The problem with this recommendation, however, is that a number of well controlled studies have shown that supplements of these vitamins, while they did lower homocysteine levels, did not reduce the number of heart attacks or strokes in the study participants.

In marked contrast, many clinical trials have conclusively shown that lowering LDL cholesterol levels (through the use of the very drugs Dr. Douglas advises us not to take) significantly reduces the incidence of heart attacks and strokes.

Because myths do abound in medicine, myth busters have a valuable role to play. But to be useful, myth busters must first choose real myths to debunk, rather than attempting to discredit well established findings and to replace them with new myths of their own devising.

Check the Internet for "cholesterol myths" and you'll find plenty of others who question whether cholesterol is dangerous and who doubt that lowering it will confer any benefits.

One example is Uffi Ravnoskov, M.D., Ph.D., and his book titled The Cholesterol Myths. A number of statements on his Web site are correct, but I'm not tempted to read his book because he also says there, "The only effective way to lower cholesterol is with drugs, but neither heart mortality or total mortality have been improved with drugs the effect of which is cholesterol-lowering only. On the contrary, these drugs are dangerous to your health and may shorten your life."

The danger of reports by Dr. Douglass and other misguided truth-seekers is that some laypeople may believe them and fail to follow lifestyle measures or take proven medications, when needed, to protect themselves against a heart attack or stroke.

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