It’s never a good thing when your cardiologist sounds alarmed on the phone. Come in tomorrow, he said: we’ll get you on the table. He wasn’t talking about cracking my chest, thank Christ, but threading a wire in through a vein to get a look at the heart, blow up a tiny balloon to stretch the artery, and maybe leave behind a metal tube or three.
I wasn’t keen on that last part. Then I thought: serves me right. I should have avoided all those bacon sandwiches and steaks fried in butter. ‘The wages of sin is death.’ Probably should have taken the statins, too. But if you are, understandably, unwilling to take a fistful of pills every day for the rest of your life, there are some medical mavericks to confirm your decision. If they are wrong, though, their advice could end up killing more people than Hitler, Stalin and Pol Pot combined.
As the great smoker and drinker Christopher Hitchens put it, when you get a serious diagnosis, you cross ‘from the country of the well across the stark frontier that marks off the land of malady’. He wrote that after being trolleyed out of a New York hotel room barely able to breathe, chest filled with ‘slow-drying [cancerous] cement’.
I feel a fraud when people ask, solicitously, if I’m OK. I’m not Julie Burchill, consigned to a wheelchair, possibly for life, or Roger Lewis, dropping to the ground in a Morrisons car park without a pulse (he survived). I have no symptoms, no elephant squatting on the chest, not even shortness of breath. But the first symptom of a heart attack is often a heart attack. Lying on a chilly operating table, I could see the problem on a big screen: a couple of arteries pinched at numerous points, one narrowed to a thread all the way down. So how did I get here?
Much of the medical profession agrees on what constitutes the primrose path of dietary dalliance. The puffed and reckless libertine sits on the couch all day and eats like Donald Trump: cheeseburgers, for example. Saturated fat – dairy, red meat – raises blood cholesterol. The notorious ‘bad cholesterol’ – LDL – enters the artery wall, where it goes rancid and pulls in a swarm of the immune system’s white blood cells. They clump together, narrowing the artery. These fat-filled plaques can pop like a pimple. Then you get a clot, and collapse in a supermarket car park. This is the lipid theory of heart disease and there’s a huge amount of evidence that lowering blood LDL with statins stops the process.
Ten years ago, various doctors looked at my sky-high cholesterol numbers and told me to take them. Naturally, I didn’t listen. Like most people, I have a large capacity to avoid facing unpleasant facts. Atherosclerosis is a silent killer: a slow-moving, distant, hidden threat, not the tiger about to pounce that our brains evolved to fear. It’s all too easy to find an alibi for carrying on as before.
Joseph Mercola, whose message is ‘Forget cholesterol’, is not a cardiologist. He’s an osteopath
If you’re searching for an excuse not to act, google ‘heart disease’ and you’ll get a flood of opinion denying conventional medical wisdom. Cholesterol doesn’t damage arteries: it heals them. The problem isn’t fat: it’s sugar, or carbs. Go ahead, enjoy that cheeseburger, just without the bun. You can even learn that the heart isn’t really a pump at all: the blood will go round by itself (someone killed a dog to demonstrate that). Some of the people saying these things are doctors, a few are even cardiologists; some have no medical qualifications at all. But they are all excellent communicators.
Joseph Mercola wears a white coat and a reassuring ‘Trust me, I’m a doctor’ expression in his publicity picture. His message is ‘Forget cholesterol’. High LDL, he says, may even be good for you. But ‘Dr’ Mercola is not an MD, let alone a cardiologist. He’s an osteopath. Still, he has one of the internet’s biggest health sites. He’ll sell you an indoor tent to shield you from ‘harmful electromagnetic frequencies… the perfect solution for health-conscious individuals’. $499.97, with free shipping. His main business is antioxidant supplements that a (real) doctor who blogs as ‘the sceptical cardiologist’ says are ‘useless… Mercola sells so much snake oil it is mind-numbing’. Mercola has said that he tells the truth as he sees it: ‘People call me a snake-oil salesman, of course… I don’t think there’s a justification for it.’
Though he appears on Mercola’s website, Malcolm Kendrick is a proper MD, a GP, even if he’s not a cardiologist, and he flogs no supplements. He is persuasive because he cites detailed evidence for his arguments. His book The Great Cholesterol Con helped to persuade me not to take statins a decade ago. ‘Statins kill people,’ he writes: they can cause cancer, ‘dissolve’ muscle, destroy the kidneys, ruin the brain and might give pregnant women ‘horribly deformed’ babies. They can even ‘cause’ heart disease. He says: ‘The misguided war against cholesterol, using statins, represents something very close to a crime against humanity.’ (The argument about Hitler, Stalin and Pol Pot can work in reverse.)
If, as Kendrick writes, statins have a ‘complete lack of any benefits’, then why do most doctors believe in them? His answer: Big Pharma. Kendrick claims there are links between ‘all prominent cardiologists’ and pharmaceutical companies that put profits before patients. ‘Imagine how much money they would lose if we could actually prevent, or even cure, cardiovascular disease.’ These are the beliefs that get Dr Kendrick labelled a fringe theorist and are what I find most off-putting about his cholesterol-scepticism.
No doubt my cardiologist makes a nice living, but I don’t think he’s part of a vast conspiracy to give me medicine that will make me sick. For the time being, then, I’m taking the statins. I’m also trying not to be such a ‘pudgy puff-ball’ (as Alan Clark said of Ken Clarke). The other piece of advice from the cardiologist was: don’t read too much about diet, you’ll only get confused. Eggs used to be bad; now they’re good. Milk might be OK too (unless you’re Japanese). Saturated fat is moving out of dietary hell and into purgatory, though the evidence is ambiguous.
I’m on the Mediterranean diet. Unfortunately, this means eating like a Sardinian peasant 100 years ago, not loads of pizza and pasta. So show me the steep and thorny way to heaven and – I say this with the utmost reluctance – pass the kale, please.
Paul Wood and cardiologist Dr Christopher Labos joined the latest Edition podcast to unpack the truth behind cholesterol:
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