The great fish oil scare of 2013 and how to understand scientific studies.

Going back to last years scare that fish oil supplements can cause prostate cancer. This study came out and the media jumped on it and ran. The study some how said that omega 3’s were a cause for cancer and almost overnight I was slammed by text messages and emails from people telling me I’m going to get cancer now….

I came across this great article that not only explains the actual study that was done but also gives you some good info to use when the next big study pops up and throws the world into a tumultuous spin.

Research Review: Fish oil & prostate cancer

A recent study linking Omega-3s and prostate cancer caused a media storm and frightened a lot of people.

But before you stop taking your fish oil, pay attention to the kind of study this was, and remember – correlation does not equal causation (more on this below).

When it comes to using research to make real-life decisions, study design matters.

Introduction

A new study appears and it’s all over the news.

Vitamin X or food Y is correlated to cancer, heart disease, or stroke!

Suddenly people start avoiding vitamin X or food Y.

But hold on. What does it mean to say that two things are “correlated”, anyway?

Correlation: A mutual relationship or connection between two or more things.

If you ever hang out with geeks like me, you’ve probably heard us mutter things like, “That’s correlational, not causational”, or, “That was only a correlation.”

With flashbacks of your last math or stats class, you nod blindly and hope the conversation moves on to something more interesting, like a princess having a baby.

But have you ever wondered why we get so worked up about correlational studies in the first place?

Actually, it’s not correlation itself, or even correlational studies, that are the problem.

The problem comes when correlation is confused with causation.

To put it simply, just because two or more things happen at the same time doesn’t mean that one causes the other.

Ice cream causes murder

Here’s an example to make this clearer.

One very well known and repeatable correlation is that murder rates correlate to ice cream sales.

ice cream chart Research Review: Fish oil & prostate cancer

Yes! Strange as this may seem, as murder rates go up, ice cream sales in most cities also rise.

Let’s look at a couple of possible explanations.

HYPOTHESIS 1: MURDER CAUSES PEOPLE TO EAT ICE CREAM.

Here, I’m making the reasonable assumption that people buy the ice cream because they plan to eat it.

A few problems with this idea:

  • Even though ice cream sales and murders increase at the same time, lots of people buy and eat ice cream, not just murderers. In fact, even if every murderer bought ice cream after committing the deed, this would make no statistical difference. Thankfully, ice cream sales are always higher than murder rates – even though both tend to increase at the same time.
  • If committing murder caused people to buy and eat ice cream, then nabbing bad guys would be as simple as hanging out at ice cream parlors and grocery stores near the freezer department! But last time I looked, policing wasn’t quite that easy.

HYPOTHESIS 2: BUYING OR EATING ICE CREAM CAUSES MURDER.

Now, not having ice cream may indeed lead to a murderous desire for ice cream.

But if that were the case, you’d think that the murder rate would be higher whenever ice cream was in short supply — and sales figures were correspondingly low.

In fact, sales go up as murders rise. So maybe it’s a post ice cream high or a sugar crash that turns ice-cream buyers into murderers?

Problems with this idea:

  • If this were true, then banning ice cream would stop murder. Hmm. I don’t think it’s quite that simple. After all, before ice cream was invented, we had murders. And in places where nobody has ever heard of ice cream, they still have murders.
  • Ice cream parlors would be the epicenter of murders.  But see hypothesis 1 above.

HYPOTHESIS 3: THE CORRELATION IS DUE TO RANDOM HAPPENSTANCE (COINCIDENCE).

This is similar to the correlation between the decrease in pirates and climate change / global warming. (Yep, that correlation also exists.)

So, although the association between murders and ice cream may be random, I think there’s a better explanation…

HYPOTHESIS 4: SOMETHING ELSE CAUSES THE INCREASE IN BOTH MURDERS AND ICE CREAM SALES.

Let’s try this on for size:

Warmer weather is probably the cause of both increased murders and increased ice cream sales.

Note that this is also a correlative explanation. But it’s the best one we’ve come up with, so far.

Silly examples don’t count

Okay, okay, the ice cream sales and murder correlation is a silly example.

When it comes to legitimate scientific studies, nobody would really make the mistake of thinking that correlation is proof of causation, right?

Wrong.

Actually, the scientific research is littered with examples of people doing precisely that.

The most famous of these may be the studies linking hormone replacement and the prevention of coronary heart disease.

Hormone replacement therapy studies

Back in 2012, we discussed one of these studies.

To summarize, back in the 80s and 90s, because scientists had noted a correlation between estrogen replacement therapy and a decreased risk of heart disease, many women were put on estrogen replacement by their doctors.

Twenty years later, a controlled randomized study showed that in fact, estrogen replacement was very bad for heart disease! Oops.

How could a mistake of this magnitude occur?

It turned out that women of higher socioeconomic status who were more interested in their health (or better positioned to do something about it) were much more likely to ask for or agree to take estrogen than poorer women who had less access to health care.

And while on the surface it may have looked as if hormone replacement therapy reduced a woman’s risk of heart disease, in fact, it was a woman’s socioeconomic class that actually predicted that risk.

Middle and upper class women were less likely to suffer from heart disease –despite the fact that more of them were on hormone replacement therapy, notbecause they were on hormone replacement therapy.

In the end, here’s the important point: correlational studies are usually based on observation. What this means is that researchers gather information without making inferences.

They do this either with questionnaires, or by taking direct measurements (blood pressure, ice cream sales, etc.). They then let the statistical hamsters process the information (data).

Most long-term “people” studies are observational. And while this methodology sounds fine, it’s very weak. Because it can’t prove anything. It can only find when things are related.

Like ice cream and murder.

Pirates and climate change.

Birth control and heart disease.

Causation

Now that I’ve done my share of fist-shaking about correlation, I’ll tell you about causation and how to prove it.

Causation: To cause something to happen.

Yes, it’s as simple as that. To cause something is to make it happen.

If I hit you in the head with a baseball bat, that causes your head to ache. This relationship is causational.

There is a cause (getting hit in the head with a baseball bat) and an effect (a headache).

You might see a potential problem right away here.

Sure, hitting you in the head is likely to lead to a headache. But maybe you had a migraine before I hit you.

So the key to showing causation is to control for everything other than the hypothesized cause.

That’s why we call studies with this design “controlled experiments.”

And when you want to prove causation, the ideal is a very specific type of controlled experiment, called a double blind randomized controlled experiment.

Defining the terms

Okay, I’m about to go off on a little research tangent.

Mostly because I think it’s important for you to understand the difference between various types of studies. Especially if you want to figure out how to interpret the fish oil one.

But, if you already know this stuff, or you’re simply not interested, feel free to skip down to the fish oil and prostate cancer part below.

DOUBLE BLIND

The phrase “double blind” has nothing to do with eyesight. Instead, it tells you who is aware of the conditions of the experiment.

As strange as it sounds, in a double blind study, neither the volunteers (subjects) nor the experimenters know exactly what is going on.

The experimenters merely collect the data. Only a third party, who is not doing the testing, is aware of the whole story.

From this you can probably guess that a “single blind experiment” is one where only the subjects are in the dark.

With the estrogen replacement double blind study, the researchers didn’t know who was on estrogen and who was on placebo.

But before the blind was removed, they were convinced that the women taking estrogen were doing better.

In fact, they were so certain of this that they felt it was unethical not to stop the experiment immediately and give estrogen to the entire group!

Why bother conducting blind experiments?

One reason is that it reduces the possibility of researcher bias. That’s important because researcher bias can sometimes influence results.

(In fact, in some cases, including the hormone replacement experiment, even making the study a double blind may not be sufficient to protect against researcher bias.)

All drug trials are double blind (using placebo and drugs). But these are the exception, since many experiments can’t be blinded.

For example, when experiments involve an obvious intervention, like exercise, eating fewer calories, or meditation, pretty much everybody figures out who is in the experimental group and who is in the control group without being told.

RANDOMIZED

Now let’s take a look at another word in the description: “randomized”. This means that subjects are randomly assigned to groups.

Typically, studies like this will include a control group that receives a placebo or no intervention.

And an experimental group that gets the intervention – whether that’s a drug, exercise, a supplement, or something else.

The participants are sent into one group or the other in a completely random way.

CONTROLLED

A “controlled” experiment is one where the researchers control the intervention.

If that’s a drug, they control who or what gets the drug, how much, when, for how long, and pretty much everything else you can think of regarding the drug.

Researchers also try to control everything else that may change following the intervention.

For example, let’s say that people start to exercise as a part of a study.

In real life, when people take up exercise, they’ll often start to eat differently than in the past. This is a confounding variable — the arch-enemy of controlled experiments.

So in such a study, researchers should control for diet. They might ask people not to change their usual diet until after the experiment is over.

If a controlled experiment is appropriately set up, at the end researchers can be pretty confident in their conclusions about those specific conditions. But they can’t use their results to draw definitive conclusions about much else.

In other words, controlled experiments have limited generalizability.

Correlation versus causation

Now that you understand the difference between correlation and causation, let’s compare the advantages and disadvantages of each type of experiment.

CORRELATION EXPERIMENTS CAUSATIONAL EXPERIMENTS
Type of study
Epidemiological Double-blind, randomized
Number of subjects
Lots – 100 to 100,000 Few – 5 to 50
Length of study Long – years to decades Short – days to months
Measures Usually lots Vary, but tends to be fewer than correlational
Driven Data-driven Experimental design-driven
Statistics Lots of stats using models, regression analysis and sometimes t-test (ANOVA) Less stats using comparative tests (t-tests)
Humans or animals Nearly all human Mostly animals (except in stage 3 drug trials)
Advantages Able to uncover surprising connections and relationships Able to prove causation
Disadvantages Unable to prove causation or explain the relationships found Limited applicability or generalizability. (All studies should focus on yes or no answers to the question the study was designed to answer; the hypothesis must be accepted or rejected).

Both types of studies and data interpretation have their place. And adopting only one or the other would seriously limit our capacity to understand the world around us.

Correlational experiments and results stretch our minds by suggesting previously unimagined possibilities. Maybe ice cream really does cause murder! Let’s investigate that some more!

The problem with correlational studies is that they can’t give us certainty. Meanwhile, experimental studies give us certainty, but only within a very narrow range. Often, they can’t be performed on humans.

For instance, the definitive study on smoking as the cause of lung cancer was done on primates, since it would be unethical to randomly assign people to the smoking habit.

(In fact, many people argue that it’s unethical to perform such experiments with primates – but that’s a topic for another article.)

Research question

The reason we’ve gone into this detail about study design is simple: to make sense of this week’s review, you need to understand the potential drawbacks of correlative studies.

This week’s study asks: Is there an association between plasma phospholipid fatty acids and prostate cancer risk?

Brasky TM, et al. Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial. J Natl Cancer Inst. 2013 Jul 10. [Epub ahead of print]

Subjects and methods

The first thing you need to know is that this study was a study-within-a-study. For you artsy types, that’s sort of like a play-within-a-play.

The main study was a causational study called SELECT that gave a group of 834 men Vitamin E and selenium to see whether this would decrease their rates of prostate cancer.

(This study concluded that vitamin E and selenium didn’t prevent prostate cancer.)

In fact, vitamin E actually increased prostate cancer rates — although the dose was probably too high, which makes it tricky to generalize to a more reasonable dose.

(Incidentally, that’s actually an interesting finding and was lost in all the fish oil debate.)

In the study we’re reviewing today — the study-within-the-study, which was correlational in design — an additional 1393 more prostate cancer-free men joined the original group of 834 guys.

(These were matched for age, race, education, BMI, smoking status, alcohol consumption, family history of diabetes and prostate cancer, and SELECT group.)

Researchers measured the blood plasma levels of omega-3 fatty acids and trans-fatty acids in those who had prostate cancer and those who did not.

Results

More men with the highest levels of long-chain omega-3 polyunsaturated fats in their blood (total of EPA, DPA and DHA) had low-grade, high-grade, and total prostate cancer.

This is what grabbed the headlines, but there’s more. (And this is the crazy part.)

More men with the highest levels of trans-fatty acids in their blood did not get prostate cancer.

So, according to these correlations, the men who did get prostate cancer had more omega-3s in their blood.

And the men who didn’t get prostate cancer had more trans fats in their blood.

Odd.

Conclusion

Okay, so before you stop taking omega 3s and fish oil because of this study, here are a few things to consider:

This is a correlational study. Like the ice cream and murder study. So we can’t say whether omega 3s cause prostate cancer, prostate cancer causes omega 3s to appear in the blood, or if some other common factor causes both. (Not can we say anything about the causal relationship between trans fats and prostate cancer.)

The researchers measured blood serum levels of omega-3s, not dietary consumption of omega-3s. And the correlation between eating omega-3s and blood serum levels of omega-3s is weak.

Aging may decrease omega-3 consumption and/or deregulate blood serum levels of omega-3s. That means that the problem could be blood serum omega-3 deregulation, not dietary consumption of omega-3s, or the omega-3s themselves.

Serum omega-3 levels rise for fewer than five hours after eating fish or taking fish oil. Forty-eight hours after you take fish oil, your serum levels are back to baseline.

There was no data on how much fish or omega-3s the subjects consumed. None. Based on population data, it’s unlikely that many of these guys were supplementing with fish oil in the first place.

So maybe eating more omega-3s in fish or fish oil form raises the blood serum level of omega-3s, and higher levels of omega-3s in turn cause prostate cancer.

Or maybe prostate cancer causes a dysfunction in the body that also raises omega-3 levels.

Or maybe some physical dysfunction raises both blood omega-3 levels and causes prostate cancer.

In other words, this study doesn’t demonstrate that omega-3 fatty acids cause prostate cancer any more than a spike in ice cream sales explains an increase in murders

Bottom line

KNOWN RISK FACTORS

Before throwing out your fish oil, let’s talk about the more important risk factors for prostate cancer, such as:

  • age;
  • ethnicity/ancestry (for example, men of African descent have much higher prostate cancer mortality rates than men of Asian descent);
  • genetic makeup (although, like breast cancer, the genes we know about to date are responsible for fewer than 10% of cases);
  • family history (i.e. having other close relatives with prostate cancer);
  • previous cancers (even if they’re other types);
  • systemic inflammation;
  • poor diet and sedentary lifestyle;
  • obesity (because adipose tissue is inflammatory if you have too much of it); and/or
  • the hormonal environment (such as inappropriately elevated levels of IGF-1).

(Heck, even this interactive map of world prostate cancer incidence and mortality shows that there are significant regional variations.)

And unlike the correlational studies (which, again, simply say that X happens at the same time as Y), we know the causal mechanisms by which many of these risk factors above actually work (in other words, X causes Y because Z).

As a result, we know that fish oil supplementation can actually improve a few of them, including inflammation, obesity, and the hormonal environment.

OMEGA-3S ARE STILL GOOD FOR YOU

While the media have jumped on this particular study as newsworthy, many other studies suggest that omega-3 fatty acids prevent prostate cancer (perhaps by controlling inflammation or lowering the cell signaling molecules that could stimulate cancer cell growth), or have no effect at all on prostate cancer.

Meanwhile, omega-3 fatty acid consumption has been found helpful for everything from Alzheimer’s to joint pain.

And the most convincing data demonstrate that omega-3s decrease blood triglycerides and cardiovascular disease – diseases that pose a greater risk for most men than prostate cancer.

So before you avoid omega-3 fatty acids, recognize that in doing so, you’d be giving up proven benefits for unproven risks.

In our view, the benefits of omega-3s still outweigh any risks.

References

Click here to view the information sources referenced in this article.

The Grain Brain

The Grain Brain

Most new research talks about how carbohydrates like wheat, flour, and sugar are bad for you. Bad for your waistline, energy levels, and heart health.

However, in his new book, Grain Brain, Dr, David Perlmutter discusses the relationship between carbohydrates and the brain. Dr. Perlmutter uses detailed evidence to support his hypothesis that carbs are destroying your brain.

From the start of the book, Dr. Perlmutter gets to the point by stating, “Brain disease can be largely prevented through the choices you make in life.” Our modern society has moved from using food to maintain a healthy body to using medicine to fix a broken one. This thinking is flawed and ineffective, and we are encountering more illnesses that cannot be fixed or cured, like dementia and Alzheimer’s disease.

Also, the foods we consume today, including grains, are not the same foods we were consuming 70 years ago. Our bodies are ill-equipped to process things like flour, sugar, low-fat foods, and mostly anything processed. According to Dr. Perlmutter, most of what we are told to eat is grossly flawed. Our brains need good fats and cholesterol to survive. Take the fat out of our diets and the brain muscle starts losing its strength.

Dr. Perlmutter describes many patients he has seen who have come to him with various brain-related issues who, after cutting carbs out of their diets, have seen a dramatic change in their bodies.

This book is ideal for those who have an interest in maintaining a healthy body, fixing a “broken” one with diet and healthy habits, or those who are curious about what carbohydrates do to the brain.

Good stuff about cholesterol

JIMMY MOORE DISCUSSES HIS NEW BOOK CHOLESTEROL CLARITY: WHAT THE HDL IS WRONG WITH MY NUMBERS?

Posted September 10, 2013 by 

Recently I interviewed Jimmy Moore, of the hugely popular low carb Podcast Livin La Vida Low Carb, about his new book Cholesterol Clarity – What The HDL Is Wrong With My Numbers?

Gary Collins Primal Power Method - Interviews Jimmy Moore Cholesterol Clarity Livin La Vida Low Carb

 First a little about Jimmy:

In January 2004, Jimmy Moore made a decision to get rid of the weight that was literally killing him. At 32 years of age and 410 pounds, the time had come for a radical change of lifestyle. A year later, he had shed 180 pounds, shrunk his waist by 20 inches, and dropped his shirt size from 5XL to XL. After his dramatic weight loss, Jimmy was inundated with requests from friends, neighbors and complete strangers seeking information and help. Jimmy is dedicated to helping as many people as possible find the information they need to make the kind of lifestyle change he has made. To that end, he has started a blog and a number of websites to get out the message of lifestyle change and healthy living. Here you will find links to Jimmy’s blog, his YouTube videos and all of the websites he contributes to.

The Interview:

Gary Collins: What prompted you to write the book about cholesterol and the myths surrounding it?

Jimmy Moore: Oh man. There are so many misconceptions about cholesterol out there that I just felt like none of the books that have been written about cholesterol really have addressed it from this perspective. I mean, it’s all been one of two things, Gary. It’s either been, don’t worry about your cholesterol, or it’s more of that conventional wisdom of looking at it as lower your fat and when that’s not enough, take a statin drug. Now, I didn’t like either one of those things because I think obviously the latter is wrong, but the former also forgets that people in the real world do care about their cholesterol. They do worry about their cholesterol, so why not have a book out there that not only says, okay, here’s why you might not want to pay attention to cholesterol, why it may not be an important factor in your heart health as you’ve been told, but I know you’re still going to worry about it anyway so why don’t we give you things to shoot for. Why don’t we give you numbers to aim for and give you the right markers to take a look at that will truly determine whether your heart is healthy or not. Unfortunately, it’s all been whittled down these days to LDL cholesterol and total cholesterol and the reason why is, as you know, very well know, there’s a statin drug that can be sold to people to the tune of $29 billion annually and as long as that money train keeps happening, we’re going to keep on looking at total cholesterol and LDL. I think for the rest of us though, let’s look at health.  How is our actual heart health? And we talk all about those things throughout the book, what you can actually look at to see how your heart is doing, and it’s not total and LDL.

Gary Collins: So you’re saying that this money thing seems to surround the controversy a little bit?

Jimmy Moore: I think it’s totally predicated on the money thing.

Gary Collins: Yeah.

Jimmy Moore: You take away the $29 billion being made on statin medications like Lipitor and Crestor—you take those out of the whole system—and tomorrow, Gary, there’s no more focus on total. There’s no more focus on LDL cholesterol. It will now shift to triglycerides, HDL, and the ratio between those two. It’ll shift to inflammation and CRP levels, which we talk about in the book. Those kinds of things. And then the CT heart scans of the chest to see if any calcified plaque is actually happening in your arteries. You know, I think if you remove the financial incentive to treat numbers on paper and actually start treating disease—the way we look at these things, the way we talk about it—cholesterol clarity is totally going to shift.

Gary Collins: And your book does a phenomenal job. I touch on it here and there in some of my writings in the Primal Power Method, but that was the first book that I’ve read that really went into the topic in depth. You tell your story and go through all of your markers and what they meant, and I think that’s important for people to be able to follow…that you went through it. You had to deal with it. You had to come to your own conclusions through your own research, which I think is very important.

Jimmy Moore: Yeah, I think that’s the future of healthcare to be honest. People are going to grab back control of their own health. As a patient, people go to see their doctor and they expect their doctor to have all the answers. You’re the one that has to actually do the research on yourself and quite frankly, Gary, you know your body better than anybody else. So why don’t you use your doctor as a consultant in your overall healthcare? But you have to be the final arbiter of whether you truly need that statin medication or if the rest of your health is telling you you’re pretty darn healthy, never mind, Doc, I’m going to skip it and I’m going to keep on keeping on with my nutrition.

Gary Collins: I think one of the key stats you brought out in your book was that only 15% of the cholesterol in your body is determined by food, and only 15% of that ends up in your total blood cholesterol.

Jimmy Moore: And that’s shocking to people too because you see all these low fat, low cholesterol, heart healthy symbols on all of these kinds of foods, and yet, it was Dr. Peter Attia who actually had that quote. In the midst of writing this book, I attended a medical conference in April and he gave a talk on cholesterol. That’s when he shared that statistic and all the doctors in the audience kind of gasped a little bit when he said 85% of it’s not even absorbed by the body, and that’s shocking to medical professionals.

Gary Collins: Yeah.

Jimmy Moore: So what about all of those laypeople out here who are hearing all these messages of cut your saturated fat, cut your cholesterol? Well guess what, folks?  It’s not the culprit.

Gary Collins: You start your book off with one of your quotes: “If you like straight talk that cuts through the muckity muck, you’ve come to the right place. The title of this book is Cholesterol Clarity For a Reason. The intention is to make the truth about cholesterol absolutely clear.” And that is the defining moment of the whole book. It’s to say, all right, enough of the crap.

Jimmy Moore: Yeah.

Gary Collins: We’ve heard enough of it and I mean, $29 billion and climbing…that has to change.

Jimmy Moore: Right.

Gary Collins: Bottom line is it’s not going away. And as you know, I used to investigate this stuff and the two biggest counterfeit drugs were Lipitor and Crestor and also the ED dysfunction drugs, which go together and that’s what people don’t understand.

Jimmy Moore: Right.

Gary Collins: That’s why those were always the top ones because if you have all the symptoms of say, high cholesterol today, they would put you on erectile dysfunction medication too. Amazing how all that went together.

Jimmy Moore: Yeah.

Gary Collins: So did you find any pattern in the medical community when it came to cholesterol and the beliefs?

Jimmy Moore: There’s one whole chapter where we go through all the major health groups that are out there and what their views are on cholesterol. So you’ve got everything from the Mayo Clinic to the American Heart Association and their obnoxious little heart symbol they have on all these foods that are not healthy. Also the American Diabetes Association. On and on and on, all these top health groups. It was almost like they got together and colluded on what their message would be, and every one of them is: limit your saturated fat to no more than 7% of your diet just like the USDA is telling us to do in the dietary guidelines… and that’s truly where they get a lot of their information. Well, if it’s good enough for the U.S. government, it’s good enough for us. So they kind of implement that as their modus operandi.  But then they go to cholesterol and they say, well total cholesterol needs to be under 200 and LDL cholesterol needs to be under 100 and if eating a low fat diet doesn’t do enough, you need to take a statin drug. So it’s almost as if a memo got sent out. This is the way we cure heart disease, by artificially lowering cholesterol levels on paper to under 200. But unfortunately, and a statistic we put in the book is, they did a study where people went into the hospital for a heart event of some sort. So they had a heart attack, some kind of cardiovascular event. You want to know what percentage of them had high cholesterol compared to those who had normal levels under 200 of cholesterol? The high cholesterol, you would think, would be 75-80% right?

It was just the opposite.  Seventy-five percent—three out of every four patients admitted to the hospital for a heart attack or some kind of heart-related event—had cholesterol levels that would be considered healthy by every doctor in America. They were under 200, whether they were artificially lowered to under 200 with a statin or whether they just had naturally low cholesterol, it was three out of four. And yet, if you would have asked most people, they’d say, oh, 75-80% of them have to have cholesterol levels well above 200 because we know cholesterol is the culprit in heart disease.  But cholesterol is not the culprit in heart disease.

Gary Collins: The first time I read that was, I believe, in Gary Taube’s book. I can’t remember if it was Good Calories, Bad Calories or Why We Get Fat, but I remember him talking about it, and it was the first time I had ever heard it.

Jimmy Moore: Right.

Gary Collins: And I was like, holy cow, I’ve been sold a complete bill of goods.

Jimmy Moore: We all have.

Gary Collins: With my background, I was inside it and I got to see a lot of interesting things. But during your research, would anyone in the pharmaceutical industry even talk to you about statins?

Jimmy Moore: You know, they weren’t interested. And to even take it further, my own doctor wasn’t interested.

Gary Collins: Wow!

Jimmy Moore: For the book, I was going to try to get some traditionally trained doctor to explain how he treats patients and I thought, well who better than my own doctor? And I went up to his clinic and I said to the front desk person, I’d like to interview my doctor for a book I’m writing about cholesterol and heart disease and blah, blah, blah, would he be interested? And so, she took my name and number. Never heard back from him. Now of course, you know me, when I get an interview with my podcast, I’m always following up and everything. I followed up two or three more times and when I never heard something, I said, you know what? This is telling. This is telling that my own doctor won’t even talk to me because I think deep down inside, Gary, even he knows the way we’re treating heart health issues in America—and around the world, quite frankly—is dead wrong.  But he doesn’t, and he’s not alone, he doesn’t want to stop the gravy train. I’m just thoroughly convinced there are a lot of doctors who are getting a lot of kickbacks from pushing these drugs—and not just statins but really all drugs—on their patients. And what’s really salacious about this tale is patients are watching television. So they see a commercial from Lipitor that says, go lower and ask your doctor how you can go lower in your cholesterol. And then they send pharmaceutical reps in to “educate” doctors, look at these pills that will lower cholesterol and by extension—they may not say it overtly, but by extension—help with heart health. These two things happen at the same time and then a patient goes in with a 225 total cholesterol and their doctor says, well I have this miracle drug that will help lower that cholesterol and make you healthier and the patient’s like, oh yeah, I saw a television commercial that told me to ask my doctor, so let’s talk. And so the pharmaceutical company looks back and says, look, we had nothing to do with that. And yet they propagandized both the patient and the physician and act like nothing was their fault. It was totally propaganda at its finest.

Gary Collins: I just had a talk with a new client the other day about the medical industry. And I said, we’re spending nearly $3 trillion on healthcare in the U.S. a year. You think there might be some corruption in there, just a tad? And off-labeling with reps…we dealt with that a lot when I did my investigations. I didn’t know any rep that didn’t go in and talk about off-labeling. They all did it, it was common practice. For people who don’t know what it is, it is recommending a drug for something other then its original intent.

Jimmy Moore: Right.

Gary Collins: Yeah. Which technically is illegal, but we both know not much ever happens when they are caught. The drug manufacturer will pay a civil or criminal fine and that is it…move on, nothing to see here.

Jimmy Moore: Well, and they’re doing that now with even the statins. They originally were to lower cholesterol. Now they realized that message, and hopefully after my book comes out, that message really doesn’t matter anymore. They’re like, well, it actually helps lower inflammation. So they’re shifting the focus even now away from looking at statin drugs as a way to lower cholesterol and more as an anti-inflammatory, which to me is flat out criminal.

Gary Collins: You’re probably shaking your head going, oh my god.  Here we go.

Jimmy Moore: Yeah. Well, they’re trying. They know the handwriting’s on the wall.

Gary Collins: You’ve taken statins in the past. I remember you talking about that. What were some of the side effects you had and how long did it take for them to go away?

Jimmy Moore: Oh, I was very lucky because in Chapter 5 of my book, I talk about some of the side effects certain people have with statin drugs and mine, I’ve determined now, were much more minimal than some of these other people. But for me personally, I took Lipitor and I started getting these joint problems and muscle aches—and I was in my early 30s at the time—and I’m going, why do I feel like I’m 80 years old? I mean, I felt just all this pain and it didn’t take long. I was on statins for maybe a week when I started feeling these and by six or eight weeks in, I was really feeling it. I remember I was going to play basketball at my local church, and I went up and grabbed the rebound, and my right thumb just went straight backwards. I had never seen that before and I drove myself to the emergency room. I remember the ER doctor who must have been pretty swift because he said, you take statin drugs? I said, yeah, why? And he said, you might want to talk to your doctor about getting off the statins because I think it might have contributed to your joint being weaker. And I went, woah. So I go to my doctor and get this, Gary, this will shock you. I told him I want to come off the Lipitor because it’s hurting my joints and my muscles. I can’t take this drug anymore. It’s hurting me. Oh, no problem, Jimmy. We’ll take you off that. I’ll get you on a better drug. And you know what he put me on?  Crestor.

Gary Collins: Nice.

Jimmy Moore: And I’m like, wait a minute. You take me off of one statin drug and you put me on another statin drug and predictably, in a few months, I was having issues. But I thought I had to do it in order to be heart healthy and so I obediently took that drug until I started my low carb diet and within a few months after low carb, I said forget this. I am coming off of these pills now that are doing nothing more than poisoning my body, and I have not looked back since. That’s been almost a decade ago that I came off of those drugs and while my cholesterol, total cholesterol and LDL cholesterol are probably higher than what conventional medicine would consider healthy, all of the important markers—triglycerides, HDL, my CRP levels, and I’ve had a heart scan done—all of those are just incredible. My current triglycerides are 37.

Gary Collins: Wow.

Jimmy Moore: My current HDL, 79. My CRP is supposed to be under 1.0.  It’s 0.55.  The heart scan which shows actual signs of heart disease happening, calcified plaque happening…I got a big fat zero on that one. So somebody tell me how I’m not healthy from a heart’s perspective just because my total cholesterol is 306?

Gary Collins: That raises a good question. I mean, what do you think is the biggest myth perpetuated by the drug companies when it comes to supposed high cholesterol?

Jimmy Moore: I think it’s a myth overall in our culture, and it’s this whole idea that saturated fat is going to raise your cholesterol to unhealthy levels. No, saturated fat is not the issue here. Carbohydrate is probably—if we’re going to nail it on one of the macronutrients—carbohydrate, by far, is doing much worse things to our cholesterol panel than saturated fat ever wished it could on its own. Because what carbohydrates are doing—and obviously I’m talking about a lot of the refined carbohydrates that are out there, ubiquitously in our food supply, grains, sugars, and even some starches for some people—what it’s doing is a triple whammy to your cholesterol and obviously, your heart health. It’s lowering your HDL. So when your HDL dips below 50, that is not a good thing, and so by robbing our bodies of saturated fat and then obediently eating more carbohydrate, we’re actually lowering our HDL level to too low. The other thing that’s happening, the second leg of the trifecta, is your triglycerides will go up. And a lot of people don’t even know what their triglycerides are, and yet, that is so key. When your triglycerides start to go above 100, you’re eating way too many carbohydrates for your body. So ideally, you want that number under 70. And like I said, mine was 37.  You do that by dropping your carbs. And then the third thing that happens when you eat carbs in your diet to an excess, is your LDL—which people think of as one number because that’s all they’ve ever seen on their cholesterol test results—your LDL actually shifts to more of the small dense kind because you have two major particle sizes of LDL. You’ve got large, fluffy and buoyant that are pretty much a non issue when it comes to heart disease, and then you’ve got these small, dense, very dangerous LDL particles that are created by two major things: eating excessive carbohydrates and vegetable oils.

Ironically, we’re told to eat more of both of those. Healthy whole grains are good for you, we’re told. And canola oil is a healthy oil. It’s got the American Heart Association’s heart health symbol right there on the front of the packaging, and yet, those two things are oxidizing your LDL, which means making them rusty and making more of the small, dense LDL. Those things, along with the statin drugs are eliminating your large, fluffy kind of LDL and putting you at a great risk for having a cardiovascular event, heart disease and all the other things that come with that.

Gary Collins: Yeah, and it’s interesting that all of us perpetuate the opposite of what the general public is told in health. It is kind of a bipolar view, but it’s the right view. And the way I understand it also is that the VLDL can’t be recycled properly by your liver.

Jimmy Moore: Right.

Gary Collins: So once it gets in there, it’s just perpetual. It just keeps kicking it back out as VLDL again because it can’t do anything with it, it’s broken. It’s like broken cholesterol.

Jimmy Moore: Yeah, and VLDL is kind of a parallel marker with your triglycerides. So the lower your triglycerides, the lower your VLDL and you have less of that recycling happening.

Gary Collins: What would be the most important fact you could give someone about cholesterol? Just a general person who has no clue.

Jimmy Moore: Stop worrying about your total cholesterol meaning something because right now the way that people look at their cholesterol, and I get emails, I probably get a dozen or two emails a week of people that are freaking out. And these are people that buy into my message already, so I can imagine what the general public thinks. But just people that already buy into what I’m talking about with low carb, high fat diets…they’re freaked out when they get a total cholesterol that has a two in front of it.

Gary Collins: Yeah.

Jimmy Moore: And I’m saying, look, that total cholesterol is like knowing the end score in a baseball game is cumulatively 25.  Does that tell you anything about the game? No. You don’t know if it was a 24 to 1 blowout. You don’t know if it was a 13 to 12 barn burner. You just don’t know what makes up that total. And here’s another kicker: there is a part of your total cholesterol that you want to be higher, and that’s your HDL. I had a lady write to me just last week. Her HDL cholesterol was 105, which is extremely high, very healthy levels of HDL cholesterol. It pushed her total cholesterol to 225 and her doctor was pushing a statin drug on her.

Gary Collins: Imagine that.

Jimmy Moore: And I’m going, almost 40-something percent of your total cholesterol is the kind you want and he’s pushing a statin simply because there was a two in front of her total cholesterol.  The big goal of this book, Gary, is to get people to stop focusing so obsessively on total cholesterol, meaning really anything, because at the end of the day, it doesn’t mean anything. Let’s look at other things. The things like triglycerides, HDL, blood sugar is a big one, inflammation markers like CRP, looking for actual disease happening with that heart scan I was telling you about and the carotid artery, ultrasound. Those are the kinds of things that I think are going to be much more important. If we could shift people away from the total and LDL and onto these things, dude, I’ll feel like this book has been a success.

Gary Collins: I agree. And it was a book that definitely needed to be written.  It’s tricky out there right now, and all the false information makes it a labyrinth for the average person. I went through it twice, to be honest with you, because even though I’m in this world, there’s so much information in there that’s useful. I loved it. I went, god, finally, someone put it all together, you know? And now it’s a resource for me and a resource that I can use to give to our clients.

Jimmy Moore: Thank you. It was very difficult to try to make it simple enough for the average person to understand while still holding true to the science that kind of supports all these things. As I was writing this, I was like, okay, I hope I’m staying true to the science. So I had my co-author, Dr. Eric Westman, kind of go in behind me and make sure I’m staying on topic here. I guess the highest compliment I got, Gary, was when he was reading through the manuscript. He’s like, I’m not seeing anything that’s wrong here. Keep on keeping on. So hopefully people understand that it’s, I guess, a basic primer to understanding all of this. But at the same time, I had these 29 experts from around the world that are truly the top in their field on cholesterol to kind of go a little more advanced. So my dream with the book is that the newbie that’s never heard of any of this stuff would read most of what I wrote, the simple part, then go and educate themselves a little more on what this is all about. Maybe listen to some of these podcasts that are out there and have been talking about this stuff, and then come back again in six months and read it again, and then they’ll understand what all those moment of clarity quotes were about from my experts. Hopefully, it’ll be a resource that will continue to educate people long after they’ve read it the first time.

Gary Collins: I think so, and I don’t think anyone will be able to find a book with more experts in the area of cholesterol, fat and heart disease on the market, period. So, excellent job.

Jimmy Moore: Thank you very much.

Gary Collins: When does it come out for all the people out there?

Jimmy Moore: August 27, 2013, it’ll be out in bookstores. It’s obviously on Amazon right now for preorder. A lot of people have been asking about the Kindle and other e-book versions. I’ve noticed it’s on iBooks now, so if you have a smart device that has the iBooks app, you can download it.

Gary Collins: Excellent. Well I appreciate it, and I look forward to more books and more discussions.

Jimmy Moore: We’re looking forward to next year, Keto Clarity, where we’re going to talk about all of the benefits of being in a state of ketosis for not just weight loss. That’s what a lot of times people hear when they hear ketosis, that it’s a weight loss diet.

Gary Collins: Yeah.

Jimmy Moore: No, no, no, it’s so much more than weight loss. So we’re going to get deeply into all the diseases that get improved through a ketogenic diet. So Keto Clarity is coming in 2014.

Gary Collins: Oh, I like that. That’ll be a good one too.

Jimmy Moore: Looking forward to it.

Gary Collins: Well, thank you, Jimmy.

Jimmy Moore: Thank you, Gary.

Click here to purchase Cholesterol Clarity

Jimmy Moore’s Links:

Livin’ La Vida Low-Carb Blog

http://www.livinlavidalowcarb.com/blog

The Livin’ La Vida Low-Carb Show Podcast

http://www.thelivinlowcarbshow.com

Other books by Jimmy

21 Life Lessons From Livin’ La Vida Low-Carb

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