Life Without a Statin is a practical guide to heart health written by a cardiologist who has long argued that the cholesterol-focused approach to preventing and treating heart disease is flawed.
At the end of 2013, the young British cardiologist Aseem Malhotra caused a sensation in the medical community and the media by publishing an article in the British medical journal.
The article argued that the fear of saturated fat and cholesterol as bad for the heart was unfounded and had, paradoxically, made the population more vulnerable to heart disease (as sugars quickly replaced saturated fat, which was demonized for increase cholesterol, in food products).
The obsession with lowering total cholesterol in people, he lamented, has led to millions of people being over-medicated with statins, a class of cholesterol-lowering drugs with common side effects and exaggerated benefits. The statin risks reported by Malhotra and another journal article were disputed, and the drug debate raged for months.
The controversy is a familiar affair for Malhotra, a vocal activist against added sugar, low-fat advice, over-medication, and the pharmaceutical industry’s influence on drug regulation and health guidelines.
For more than a decade, he has challenged the science and evidence behind the cholesterol-based approach to preventing and treating heart disease in medical journals and the media. While academic debates are good for science and policy, they are of little use to the patient who needs practical advice.
Malhotra has now condensed her unconventional perspectives into a practical guide for heart patients or anyone concerned about their cardiovascular health. His latest book, A life without statins, helps the layman, who does not have the time, the training or the inclination to launch out in science, to evaluate the individual risk, to weigh the pros and cons of taking statins and to adopt a mode of healthy life for the heart. It comes with a complete diet and health plan with recipes.
Malhotra’s claim is that most people taking statins do not benefit from them and a significant number suffer from side effects. The use of statins only makes sense in the case of high risk individuals.
A professor of evidence-based medicine, he bases it on statistical evidence as well as on case studies drawn from his clinical practice. This does not align with the perception of statins, even among physicians, as transparent communication of the risks and benefits of drugs is not part of medical practice and training.
Pharmaceutical companies often present the results of drug trials in terms of relative risk reduction, which sounds impressive, rather than the more significant absolute risk reduction, which portrays it fairly.
A more promising claim from Malhotra is that compared to taking medication, lifestyle changes are much more beneficial in preventing, treating, and possibly reversing heart disease.
In short, his advice is no different from any doctor’s advice: healthy eating, moderate exercise, and stress reduction. But basically he diverges greatly on diet in telling people to eat carbohydrates sparingly and not to worry about fat.
Behind this advice lies the central idea of Malhotra’s advocacy and arguments throughout his career: to steer the treatment of heart disease away from reducing cholesterol, which is only a marker, and towards the fight against the underlying causes of the disease.
Over the past decades, the understanding of heart disease has evolved from a simplistic view as the obstruction of the arteries with excess cholesterol in the blood to an inflammatory disorder (the body’s response to injury or infection) caused by several factors, mainly insulin resistance.
A small but growing section of doctors and researchers view high-carbohydrate diets as the main culprit in insulin resistance and the resulting metabolic disorders.
Since Malhotra’s advice deviates from the accepted official view that consumption of saturated fat should be limited to control blood cholesterol, he devotes much of the book to making it clear that there is no consistent correlation between lower so-called bad LDL cholesterol and reduced heart attacks.
Several other authors have done the job of challenging the currently accepted wisdom about cholesterol and fat by diving deep into nutritional research. The value of this book lies in its simplicity.
Malhotra presents just enough evidence to support her unconventional views and only gives information that is useful to help people improve their health. This makes the book quick and easy to read. However, a little more light on inflammation and insulin could have given a clearer view of heart disease without compromising focus and readability.
Scattered throughout the book are also some lesser known facts. For example, some studies suggest that too much exercise can lead to heart disease, that “bad” LDL cholesterol can protect older people.
A life without statins can correct some misconceptions about heart and health among the general public without being dramatic or evangelical.
This was first published in the November 1-15, 2021 edition of Down to earth