How Well Do Cholesterol-Lowering Drugs Actually Work?

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One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things like mammograms and colonoscopies to prevent deaths from breast and bowel cancer, or the power of drugs like Fosamax to prevent hip fractures, or the power of cholesterol drugs to prevent fatal heart attacks. Patients believe statin drugs like Lipitor are about 100 times more effective than they actually are in preventing heart attacks. Studies show most people wouldn't take multiple blood pressure medications if they knew the truth.

For most people, the chance of benefit is normally less than 5 percent over five years for cholesterol, blood pressure, and blood thinning drugs. Patients don't want to take drugs unless they have at least a one in five chance--even those who just had a heart attack. It's no wonder, then, that doctors seldom share these figures. Informing patients of the percentage chance of benefit from preventive drug strategies would likely substantially reduce the likelihood that patients would agree to take the drugs every day for the rest of their lives.

For the individual, this is unlikely to be detrimental; after all, there's a 95 percent chance it won't do anything for them. But for the population at large, it would make a difference, so doctors and drug companies oversell the benefits by conveniently not mentioning how tiny they actually are, knowing most patients wouldn't take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.

The best that cholesterol-lowering statin drugs appear to do is an absolute risk reduction of 3.1 percent over six years. If Dr. Esselstyn's work can be replicated in a randomized, controlled trial, then a whole foods plant-based diet will have been shown to work twenty times better, an absolute risk reduction of 60 percent after less than four years. In Esselstyn's study, 99.4 percent of high-risk patients that stuck with the diet avoided major cardiac events, such as death from heart attack.

When we have to decide whether we want to go diet versus drugs, we're not making a choice between eating healthy to prevent a heart attack or taking a pill to prevent a heart attack. Because in 97 percent of cases in the near-term, pills don't do anything. We're risking side effects for nothing, whereas if we treat the underlying root cause of the disease by eating a healthy, cholesterol-free diet, we may even reverse the progression of the disease, as seen in my video The Actual Benefit of Diet vs. Drugs.

If we stop eating an artery-clogging diet, our bodies can start dissolving that plaque away, opening up arteries in some cases without drugs or surgery. A healthy whole food plant-based diet by itself may work 20 times better than drugs to combat our #1 killer.

Now that's something doctors may want to tell their patients.

Yes, an ounce of prevention is worth a pound of cure, but a pound isn't that heavy--why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my video Why Prevention is Worth a Ton of Cure.

Sometimes preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

I've previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment, Optimal Diet: Just Give it To Me Straight, Doc and Disclosing Conflicts of Interest in Medical Research. What should we be saying? See: What Diet Should Physician's Recommend?

So why don't more doctors do it? See Barriers to Heart Disease Prevention and Find Out If Your Doctor Takes Drug Company Money.

More on Dr. Esselstyn's heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?

Of course then there's just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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How to Protect Our Telomeres with Diet

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In my video, Does Meditation Affect Cellular Aging?, I discussed how stress reduction through meditation might be able to lengthen telomeres, the protective caps at the tips of our chromosomes that tend to deplete as we age.

What about exercise? We can't always change our situation in life, but we can always go out for a walk. London researchers studied 2,400 twins, and those who exercised more may have pumped up their telomeres along with their muscles. Apparently it doesn't take much either. The "heavy" exercise group was only averaging about a half-hour a day.

These were mostly folks in their 40's, but does it still work in your 50's? Yes. A study out of South Korea found that people in their 50's who work out three hours a week had longer telomeres.

In my video, Telomeres: Cap It All Off with Diet, you can see the telomere lengths of young healthy regular folk controls at around age 20, and then at age 50. As we'd expect, the older subjects' telomeres were significantly shorter. What about athletes? The young athletes started out in the same boat, with nice, long, young, healthy telomeres capping all their chromosomes. The older athletes, in contrast to the controls, appeared to still have the chromosomes of 20-year-olds. But these were marathon runners, triathletes running 50 miles a week for 35 years.

What was it about the Ornish intervention that so powerfully protected telomeres after just three months? We saw that stress management seems to help, but what about diet and exercise? Was it the plant-based diet, was it the walking 30 minutes a day, or was it just because of the weight loss? In 2013 a study was published that can help us anser just that question.

The researchers took about 400 women and randomized them into four groups: a portion-controlled diet group, an exercise group, a portion controlled diet and exercise group, and a control group for a full year. In the video, you can see a comparison of the length of each group's telomeres. After a year of doing nothing, there was essentially no change in the control group, which is what we'd expect. The exercise group was 45 minutes of moderate-to-vigorous exercise like jogging. After a year of that, they did no better. What about just weight loss? Nothing. The same thing for exercise and weight loss, no significant change either.

So as long as we're eating the same diet, it doesn't appear to matter how small our portions are, or how much weight we lose, or how hard we exercise. After a year, the subjects saw no benefit. On the other hand, the Ornish group on the plant-based diet, who lost the same amount of weight after just three months and exercised less than half as hard, saw significant telomere protection.

It wasn't the weight loss or the exercise: it was the food.

What aspects of a plant-based diet make it so protective? Studies have associated more vegetables and fruit, and less butter, with longer telomeres. From the latest review, foods high in fiber and vitamins are strongly related to longer telomeres. However, the key may be avoiding saturated fat. Swapping just 1% of saturated fat calories in our diet for anything else can add nearly a whole year of aging's worth of length onto our telomeres.

Saturated fats like palmitic acid, the primary saturated fat in salmon, and found in meat, eggs, and dairy in general, can be toxic to cells. This has been demonstrated in heart cells, bone marrow cells, pancreatic cells, and brain cells. The toxic effects on cell death rates happen right around what you'd see in the blood stream of people who eat a lot of animal products. It may not be the saturated fat itself, however, as saturated fat may just be a marker for the increased oxidative stress and inflammation associated with those foods.

With this link to saturated fat, it's no wonder that lifelong low cholesterol levels have been related to longer telomeres and a smaller proportion of short telomeres--in other words, markers of slower biological aging. In fact, there's a rare congenital birth defect called progeria syndrome, where children age 8-10 times faster than normal. It seems associated with a particular inability to handle animal fats.

The good news is that "despite past accumulated injury leading to shorter telomere lengths, current healthy behaviors might help to decrease a person's risk of some of the potential consequences like heart disease." Eating more fruit and vegetables and less meat, and having more support from friends and family, attenuate the association between shorter telomeres and the ravages of aging.

To summarize: inflammation, oxidation, damage and dysfunction are constantly hacking away at our telomeres. At the same time, our antioxidant defenses, healthy diet, exercise and stress reduction are constantly rebuilding them.


I've asked this diet versus exercise question in a few other contexts. See:

Though dietary change appears more impactful, I'm a big fan of walking. See Longer Life Within Walking Distance and for my personal favorite exercise, Standing Up for Your Health.

For more on the role saturated fat may play in disease, see, for example, my videos Heart Disease Starts in Childhood and Treating Multiple Sclerosis with the Swank MS Diet.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

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How Many Minutes of Daily Meditation to Combat Stress?

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In the film The Holiday, Cameron Diaz exclaims "Severe stress ... causes the DNA in our cells to shrink until they can no longer replicate." Did Hollywood get the science right?

The enzyme that builds and maintains the caps at the tips of our chromosomes (called telomeres) appear to slow the aging of our cells. Do people who are stressed have shorter telomeres? To answer that question, researchers from the University of California, San Francisco measured the telomere lengths in mothers of chronically ill children--what could be more stressful than that? The longer a woman had spent being the main caretaker of her ill child, the shorter her telomeres. The extra telomere shortening in the most stressed mothers was equivalent to that caused by at least a decade of aging. We see the same thing in caregivers of Alzheimer's patients and those suffering severe work-related exhaustion. Even those abused as children may grow up with shorter telomeres.

There's not much we can do about our past, but if we manage our stress now, can we grow some telomeres back? If we go on a meditation retreat and meditate for 500 hours, we can indeed boost our telomerase activity (the enzyme that restores our telomeres)--but there's got to be a quicker fix.

In an exciting study from UCLA and UC San Francisco (highlighted in my video, Does Meditation Affect Cellular Aging?, caregivers of family members with dementia were randomized to just 12 minutes of daily meditation for eight weeks, or just about ten hours in total. The meditators experienced significant benefit, including better mental and psychological function accompanied by an increase in telomerase activity, suggesting an improvement in stress-induced cellular aging.

Here's a link to the backgrounder video that presents the original Ornish study: Research Into Reversing Aging. I cover the comparable effects of diet and exercise in my video Telomeres - Cap It All Off with Diet.

I have a few videos on using aromatherapy and other modalities to help deal with stress:

For life extension in general, see:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Nickolai Kashirin / Flickr

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