On the last episode of the Ask Prof Noakes Podcast we spoke about high cholesterol. It proved to be one of the most popular podcasts we’ve produced. It’s all about what you should know and aren’t being told about cholesterol.

Today’s episode is a follow on from that podcast and was submitted by Patricia. Patricia says that she is already on medication for high cholesterol and she wants to know if she goes on the LCHF diet can she go off her high cholesterol medication.

What you should know and aren’t being told

Prof Tim Noakes: Again, I do not want to be accused of telling anyone to go off their high cholesterol medication without having seen and examined them and that sort of thing. I therefore can’t give any direct advice.

But what Patricia needs to know is whether she has hereditary high cholesterol with a family history of people dying at young ages. In which case, she would probably be advised to stay on the high cholesterol medication.
If she just happens to have a cholesterol of 6 and she’s been told that she’s at high risk of heart attack because of cholesterol at 6. That is not true. That is the wrong information and she becomes just like one of those thousand people in America who took on Lipitor and Pfizer.

How high is high cholesterol?

She could potentially be at risk of developing type 2 diabetes. Patricia has to work out what is the supposed benefit of taking the drugs, are they proven in women with her cholesterol value and what are the risks?

To give you an example we said in the last podcast 1 in 140 patients in the men benefit, in the women we think it is even less. It might only be that I in 1000 women benefit. (I’m not saying that is the number but it could be that).

The question is then, what is the magnitude of the benefit? If you are destined to have that heart attack, it probably is going to happen and the drug will probably have very little effect.
What we know – and this is another key question Patricia needs to ask her doctor – What is the effect of this treatment on all-cause mortality? Now, I know that’s complex and scientific, but if you want to know whether your doctor really understands the problem, you have to ask this question.

What to ask your doctor about high cholesterol medication

So, if we do a study and let’s say we tell people to run marathons and we want to see if it’s good for them, the key measure is all cause mortality. For that marathon group to benefit the all-cause mortality must come down.

In other words, all heart attack risks must come down. Something must change so that they live longer. And if you live longer it is because all-cause mortality has come down. If all cause mortality did not come down, it means that that population did not live any longer. They receive no benefit in terms of life expectancy.

In other words if we find marathon runners and tell them to run marathons and they need to run the Comrades Marathon every year and we find that all cause mortality does not change, that means they all died on the same day they were destined to die despite all that running.

In statin studies in women there is no effect on all-cause mortality, which means that you die on exactly the same day. So Patricia taking her medicine will die on exactly the same day she was destined to die on. All that will happen is that the diagnosis will change. It could be from heart attack to cancer or it could go from cancer to heart attack. But it won’t change.

So you have to ask the question, Am I going to pay R800 a month (or whatever the cost is now) for the rest of my life knowing that it is not going to affect the day on which I die?

There is a real risk that it can cause complication in about 20% of people that reported. We think it is even higher than that. And in some of them it could mean serious complications.