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Interview With David Diamond The Problem With Statins

HILDA LABRADA GORE: More than two hundred million people around the world, including children, take statin drugs for heart health. Unfortunately, evidence indicates that these cholesterol-lowering drugs lead to a host of health issues and don’t actually help the heart. Neuroscientist and professor at the University of South Florida, David Diamond, PhD, was prescribed statins and decided to do his own research on cholesterol and heart disease. He found flawed studies using deceptive statistics that convinced him to run away from pharma­ceuticals. He discusses his findings, explains why he is convinced that we need to question the narrative around cholesterol, and offers concrete ideas for how to keep the heart healthy and strong without prescription medications.

David, I’ll never forget when I was in my thirties and had a friend who was thirty-five. He worried that he was “losing his mind” and attributed it to a period of “drugs and rock n’ roll” he had in his twenties. But he was also on statins because his family had a history of heart disease. I thought, “Why is he on statins in his thirties?” Later I found out that statins can play a role in poor cognitive function.

What’s the issue with cholesterol? Here at the Weston A. Price Foundation, we’re always saying cholesterol is actually good for you—but give us your perspective.

DAVID DIAMOND: First, I should say that your friend being on statins at age thirty-five doesn’t surprise me. They’re actually putting children on statins now, and the American Academy of Pediatrics (AAP) supports that. The idea put forth by the American Heart Association and most cardiologists is that cholesterol is a sticky substance that sticks to and blocks your arteries. They say you need to reduce cholesterol as much as possible—almost from birth—and that is how you will live a long, healthy life without heart attacks. And that’s completely wrong!

HG: How did you get involved in this issue about cholesterol, diet and health in the first place?

DD: My specialty is biology, with specific expertise in neuroscience. I’ve been a neuro­scientist for forty years. My area of focus was the study of the brain and memory. My career was going along just fine until I had a blood test about twenty-five years ago. The results were alarming. My blood test showed extremely high triglycerides—I was in the top 1 percent—and that is considered quite serious. I also had extremely low HDL, the so-called “good” cholesterol. I was told that the combination of the two was a killer, and basically, I was given a death sentence. They said, “If you don’t get your numbers right, you’re going to die soon.” I had about a fifteen times greater risk of dying of a heart attack, compared to a healthy person.

Although my area of expertise is brain function, I didn’t know anything about choles­terol, aside from what we all learned in biology, which is that cholesterol, a steroid or lipid, is an essential molecule of life. We make hormones like estrogen, testosterone and vitamin D from cholesterol. It is absolutely essential—the “mother molecule” of steroids.

I knew all that, but I was also concerned about my HDL cholesterol being low and my triglycerides being high. My doctor told me I was in serious trouble and recommended that I go on a statin. I’ll mention here that I’ve been very well funded by drug companies in my neuroscience research. I’m not against drugs personally or professionally, but I’ve published papers on how drugs affect the brain. After I talked to my doctor, I went back to my office and decided to read a few papers. I happen to have a genetic anomaly, and I realized that my problem was that I was eating too many carbohydrates. I learned that when I eat sugar or any form of carbohydrates, that genetic anomaly makes me extremely efficient—more efficient than most people—at converting that sugar into fat. That is what was driving up my triglycerides and put­ting me at greater risk for having a heart attack.

At that point, I put my background in biol­ogy to good use and started studying cholesterol and heart disease. It has become my second career over the past twenty-five years. I have made a scientific study of how cholesterol is or is not involved in heart disease.

HG: If cholesterol is an essential molecule for life, why has it been maligned as the root cause of heart disease?

DD: That is a great question, and the answer is a bit complicated. On the one hand, we need cholesterol to repair damaged tissue all over the body; every cell needs cholesterol. One way to look at this is that as a result of high blood sugar or high oxidized lipids—which can occur as a result of eating industrial seed oils, especially in fried foods, for example—those arteries can get damaged. What comes to the rescue is cholesterol, which is used to repair the tissue. I often compare it to the spackle you put on a hole in the wall. It would be crazy to blame the spackle as the cause for the hole.

So, cholesterol is absolutely central for repairing damaged tissue but it too can get damaged by high blood sugar. What you find is a subset of cholesterol, which, in a sense, is not natural cholesterol—it’s damaged cho­lesterol. What gets damaged is the so-called “bad” LDL cholesterol, and you see it in higher concentrations when you have high blood sugar. The two—high blood sugar and LDL choles­terol—go together; you do not have this dam­aged cholesterol in the absence of high blood sugar. You can think of cholesterol a bit like a teenager—sometimes it gets connected to a bad crowd and cholesterol gets a bad name because it’s hanging out with the wrong cohorts.

HG: Thank you for these illustrations. At times, I find the discussion of HDL and LDL and “good” and “bad” cholesterol confusing. And then some people tell me, “The problem isn’t with HDL, but with the ratio of cholesterol” and my head spins. Can you clarify that?

DD: It is the triglyceride to HDL ratio that is important. HDL is called the “good” cholesterol because in general, higher HDL is associated with better health. But what is important to un­derstand is that higher HDL is also associated with overall better metabolic health. People who exercise and don’t smoke and have low blood sugar also have higher HDL. There’s nothing magical about HDL; it’s simply a marker of good health. Triglycerides—fats in your blood—are also important. That is how fat is stored. You don’t want too many triglycerides in your blood because when triglycerides get high, your blood actually gets thicker. Ultimately, when you’re measuring the two, you want the HDL number to be about the same as the triglyceride number.

If your HDL is 60 or 70 and your triglycerides are 60 or 70, that is an optimal ratio indicating that you have good health. In my case, my tri­glycerides were 700, and my HDL was 30. Think about that. The ideal triglyceride to HDL ratio is one to one, my ratio was over twenty to one. My doctor was justified in alerting me to a dangerous situation. That was a ticking cardiovascular time bomb.

Because of the genetic anomaly, I have not been able to get my ratio down to one to one, but after I lost a good bit of weight and went low-carb, I got my triglycerides down to 150, and my HDL to about 50 to 60. There aren’t enough studies on people like me to know what kind of ratio is associated with really good health, but from what I’ve seen, my numbers may be about as low as they are going to go. There are no guarantees, but I have done well for twenty-five years and I’m now turning sixty-five. What is important to know is that someone with my genetic condition is extremely susceptible to becoming obese. I make fat very easily. If I eat a lot of carbs over the weekend, I gain five pounds just like that. I knew I could be obese if I didn’t clean up my carbs. That is why this topic is important to me.

HG: If I’m understanding correctly, the implications for the general population are that if we don’t smoke, if we exercise and if we eat a Wise Traditions diet without overdoing the carbs, our ratio should make for a healthy heart and healthy lifestyle. Is that correct?

DD: We have fifty years of good low-carb clinical trials. We also have observations of normal people on a low-carb diet. When they go low-carb, their triglycerides plummet, typically below 100, and the HDL rises, and you have a ratio that is pretty close to one to one—typically less than two or three to one. That is ideal. When you cut sugar and oxidized polyunsaturated oils—especially the deep-fried oils—you have people who have optimized their metabolic health.

HG: At the Weston A. Price Foundation, we warn people away from the seed oils found in fried foods at a roadside stand or in their chips. Those are “killer carbs” because they are made with rancid oils. We are big fans of saturated fat.

DD: I grew up with the idea that being vegetar­ian was healthy. Although I was not a vegetar­ian, I didn’t eat much meat. When my doctor first told me that I was at high risk of having a heart attack, I cut back even further on meat. I thought it was great that I was eating bread without but­ter and cheese—to show you how ignorant a scientist can be. I grew up with this idea.

Now, I completely agree with the Weston A. Price Foundation that saturated fats have been demonized and that all forms of natural saturated fats are healthy, including the tropical oils. This is important. You have vegetarians who are demonizing saturated fat, and you also have financial interests demonizing tropical oils, which are primarily saturated fats. The U.S. doesn’t produce much in the way of saturated tropical oils. It’s a political and socioeconomic battle as well.

HG: Talking about financial gain leads us back to statins. If more patients knew that a change in diet and lifestyle could improve their heart health and their overall health, the profit margin for statins would go way down.

DD: This is something I have researched heav­ily and published papers on. The idea behind a statin drug is that high cholesterol is bad for you. The way that statins reduce cholesterol levels is that they interfere with the enzyme that enables cholesterol to be formed. Bear in mind that there are published studies showing a reduced incidence of heart attacks and death in people given statins. The best ones focus on “secondary prevention,” which means they gave statins to people who had already had a heart attack and showed a reduced incidence of repeat heart attacks. On the surface, the reduction in heart attacks from taking statins—a 50 percent reduction—sounds impressive and appears to be enormous. However, what I show in my papers and presentations is how you can play with the numbers. For example, if you buy two lottery tickets instead of one, you can “double” your chances of winning the lottery, but you are just going from a one in one hundred million chance to a two in one hundred million chances of win­ning. That is how statin advocates manipulate their numbers. If I tell you there are two drugs, and one reduces heart attacks by 50 percent and the other reduces heart attacks by 1 percent, which drug would you rather take?

HG: The one that reduces it by 50 percent.

DD: It’s the same drug! This is what is remark­able. In the studies—these are real numbers— you will find that 2 percent of the people given a placebo or no drug had a heart attack, and 1 percent of the people given a statin had a heart attack. Going from two to one is 50 percent— one is half of two. This is why, in advertisements and at medical conventions, what people hear is, “You are 50 percent less likely to have a heart attack when you take a statin”—but the real number is 1 percent.

It gets even more ridiculous. There was a trial called JUPITER (“Justification for the Use of Statin in Prevention: an Intervention Trial Evaluating Rosuvastatin”). It was one of the first trials for rosuvastatin (brand name Crestor). The trial found that the rate of heart attacks in the placebo group was 0.75 percent, while the rate in people given a statin was about 0.40 percent—we’re talking about less than 1 percent of all people. But because 0.40 is about half of 0.75, the ads for Crestor said, “reduces heart attacks by 50 percent.” It’s mind-boggling. So, the public needs to understand that whatever effects statins may have are very small and only apply to people who already have had a heart attack. For primary prevention, meaning for people who have not had a heart attack, the benefit is negligible—almost zero.

HG: Most patients, if presented with alarming cholesterol numbers, are not going to do their own research and are probably going to take the recommended medication. This is disheartening because statins come with a host of side effects and complications.

DD: Indeed, the side effects have been abso­lutely minimized and ignored. I have presented and published on this. How do statin advocates discuss side effects or adverse effects? They will say that for some side effects, such as the development of diabetes, statins increase the risk from 1 percent to 2 percent, but this time, they will not explain that this means a doubling in the rate of diabetes. Or they might say that side effects increased from 5 percent of the control group to 10 percent of the people who received statins, but they will call that 5 percent increase “negligible.” We published a paper [in October 2022] in which we found around forty medical peer-reviewed papers documenting a host of adverse effects of statins, including brain fog and impaired cognition.¹ For example, there is one really important paper published over a decade ago showed that when seventy-five-year-old men and women diagnosed with dementia were taken off statins, their dementia disappeared.² They got better! And what is even more crucial to note is that when they put all of the elderly study participants back on the statins, the dementia returned. Think about the explo­sion—the epidemic—of Alzheimer’s disease we are seeing, and the fact that over half of all adults considered eligible for statins (nearly a third of adults aged forty and up) are now tak­ing them.³ How many of the people diagnosed with Alzheimer’s actually have impaired brain function because of the statins they are taking?

Understand that the brain is unique in that it makes its own cholesterol. The brain has control over its cholesterol because it needs cholesterol to be able to make new brain cells and synapses, and for memory functions. Thanks to the blood-brain barrier, not all statins are able to get into the brain, but what is interesting is that the statins that can get into the brain interfere with the brain’s ability to make cholesterol—and those are the statins that produce cognitive deficits. The study that showed the reversal of dementia indicates that the drugs can get into the brain. Think about this. The brain makes its own cholesterol and has its own machinery for doing so. A statin like Lipitor—the most widely prescribed statin—can get into the brain and stop the brain from making cholesterol; this interferes with the brain’s ability to make new brain cells and new neural networks. [Editor’s note: For another perspective on the blood-brain barrier, see the article by Dr. Tom Cowan in this issue.]

HG: My thirty-five-year-old friend was taking Lipitor, and not only could he not think straight but he had joint pain.

DD: Along with cognitive deficits, joint pain is extremely common. But the statin advocates have mounted a great effort to say these side effects are not real—that “it’s all in your head.” They try to dismiss it as the “nocebo effect” [the influence of negative treatment expectations on treatment outcomes]. They say, “You have been told that statins will cause joint pain, therefore, you have joint pain, and it’s all in your head.” It is not all in your head; it’s in your joints! Statins truly do interfere with muscle function and cause muscle atrophy. Ultimately, this also impairs kidney function, and there are studies showing kidney injury associated with statin use. You also have impaired liver function and potentially even heart failure related to statin use—and we have an epidemic of heart failure.

Along with a Wise Traditions lifestyle, it is important to appreciate that the heart depends to a great extent on ketones. Ketones nourish the heart as well as the brain. Ketones are produced as a result of a very low-carb diet. But you will not hear this kind of information in the main­stream media, which are basically a financial business. No one on a major network is going to interview me. How could they, when they are running commercials for Lipitor? Fortunately, we are getting our message out in social media, and in the medical literature through my pub­lications and in the publications of other really good people.

HG: What concerns me the most in this con­versation are the young people. You said that younger children are taking statins now. Is that because some health agency lowered the thresh­old number for cholesterol and said, “Okay, now everyone at this level can take statins”?

DD: That is an important concern. In fact, we published a response to a paper that was advo­cating statins for certain children.⁴ Let me give you some background. There is an affliction called familial hypercholesterolemia. In people with this genetic anomaly, the liver cranks out lots of LDL-cholesterol (the so-called “bad” cholesterol)—perhaps two, three or four times as much LDL-cholesterol as in someone without the anomaly. These individuals have extremely high cholesterol from birth, and a subset does indeed have heart attacks very young. This has been described for over a century. Basically, researchers found high blood cholesterol and cholesterol in the arteries of someone who had a heart attack and died at age twenty, and their logical conclusion was, “It must be the cho­lesterol that clogged the arteries.” That is why they want these children to be on statins from a young age.

However, we published a paper in 2022 in which we evaluated the same medical literature and found that it is not the cholesterol after all.⁵ It turns out that the subset of people who have young-onset heart attacks actually have a second genetic anomaly; they have high clot­ting factors (a blood clotting disorder), with one of those being an elevated protein called fibrinogen. Those are the people who die young from heart disease. If you think about choles­terol “clogging arteries,” what does not make sense is that the vast majority of people with familial hypercholesterolemia live long, healthy lives; you have eighty-year-old people with this anomaly and astronomically high cholesterol who are extremely healthy and are not having heart attacks. Our publication pointed out that this does not make sense—because it’s not the cholesterol, it’s the clotting factors.

HG: Sally Fallon Morell has told me that as we age, our body increases the amount of choles­terol it produces, and this is true even in older people who do not have that genetic anomaly. That should not be alarming. In conventional medical circles, they are always saying “Lower it,” but we actually need that cholesterol. Do you agree with that?

DD: I would not agree that our cholesterol al­ways rises with age if we are healthy. We often hear about blood pressure rising with age, but it doesn’t. My blood pressure has not changed in twenty-five years. I think what is really im­portant is to look at the person’s metabolism. In persons who are healthy, who exercise, who have low blood sugar and are not overweight, their basic metabolism is going to be stable. This is what we have to emphasize. So much of the research focuses on unhealthy people, but when you look at healthy people, you do not see the same age-related changes, as far as I can find in the literature. In studies looking at people who are healthy, their blood pressure does not rise as they age; it is in overweight people who do not exercise that blood pressure and cholesterol rise. Remember, too, that the brain makes its own cholesterol, but when you take a blood test, you are not actually getting the brain levels of cholesterol.

HG: Let’s go back to your point that it is not fat or meat that we need to avoid to get that ap­propriate cholesterol ratio, as much as it is carbs and sugar consumption that we should lower. Of course, at WAPF we are all about avoiding refined sugars and flours and going back to more ancestral ways of eating. Is there anything else you would recommend to help protect our hearts and have that right ratio?

DD: I agree with everything you just said. What we want to think about is something closer to a paleo diet. What did humans evolve to con­sume? When we think about foods that came into existence in the past ten thousand years, we are looking at entirely novel foods. It is absurd to talk about meat being unhealthy or to say meat causes diabetes. How can meat, which is something humans are adapted to consume, somehow raise our blood sugar or damage our pancreas? It makes no sense.

Or consider the big emphasis on legumes. Think about how extensively legumes have to be processed before we can even partially digest them. You may have severe reactions if you eat raw kidney beans. People need to understand that our immune system still looks at “novel” foods (in evolutionary terms) such as grains as potential invaders. When our immune system attacks wheat as an invader, this damages our colon and we get all kinds of autoimmune diseases.

I advocate thinking about what human life was like twenty, thirty or fifty thousand years ago. People were active and, to a great extent, they consumed animal foods. Humans are the apex predators; it is probable that what drove our evolution was that we were so incredibly good at hunting animals—far superior to any other creatures around. Long periods of starvation, in which we might have been dependent on eating just fruits and vegetables, were probably rare. Even then, there was not much in the way of fruits and vegetables available to us—nothing like what you see in a modern supermarket.

As far as what I recommend to remain heart healthy, it is so simple. Don’t smoke; eat meat, fat and other foods from pasture-raised animals; eliminate grains; and don’t fall for the foolishness about legumes being healthy for you. I’ll add that I do think a subset of people have problems with dairy. Dairy is a relatively new food for our species and something that resulted from the domestication of animals. Ultimately, each person needs to pay attention to how they respond to certain foods.

[Editor’s note: Dr. Weston A. Price identified many traditional groups that thrived on diets that included properly prepared grains and high-quality dairy foods. WAPF does not advocate a “paleo” diet but instead emphasizes the importance of raw whole milk from animals grazing on pasture, and advises soaking, sprouting or fermenting grains and legumes, cooking them in bone broth when possible, and eating them with plentiful butter (or other animal fats), all of which will enhance digestibility—and enjoyment.⁶]

Someone who is sedentary, overweight and eating poor-quality foods may resort to anti-inflammatories when they end up with “inflammation,” but what they really need is to change the core factors that are causing them to be unhealthy. Of course, changing one’s diet and lifestyle is a heck of a lot harder than just taking a pill. I always say, “You won’t find good health in a pill.” In my case, I have never taken a statin, and I never will. I do not take any medication at all. I feel very fortunate that my background in biology enabled me to be here, twenty-five years later, to be able to talk with you and share what I have learned.

HG: I have one more question for you. If people could do just one thing to improve their health—take one step in the direction of maybe being less sedentary or changing their diet—what would be your first recom­mendation?

DD: Exercise is good, but it is not the antidote to a bad diet and it won’t enable you to lose weight on its own. People sometimes think, “I will ex­ercise and lose weight and I’ll get healthy.” Although I advocate exercise, it is secondary to minimizing your carb consumption. Understand, too, that we are not just talking about refined sugar, which of course is bad. You want to target the foods that will raise your blood sugar. I recommend getting a continuous glucose monitor (a doctor can prescribe one) so that you can see the increase in your blood sugar. In my case, I was surprised at how high my blood sugar went if I had bread or cereal. Realize that eating bread or potatoes or even sweet potatoes is still going to raise your blood sugar. Watching your carb consumption is the primary thing, as well as enjoying life and be­ing active.

REFERENCES

1. Diamond DM, Bikman BT, Mason P. Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet. Curr Opin Endocrinol Diabetes Obes. 2022;29(5):497-511.
2. Padala KP, Padala PR, McNeilly DP, et al. The effect of HMG-CoA reductase inhibitors on cog­nition in patients with Alzheimer’s dementia: a prospective withdrawal and rechallenge pilot study. Am J Geriatr Pharmacother. 2012;10(5):296-302.
3. “High cholesterol facts.” Centers for Disease Control and Prevention, reviewed Oct. 24, 2022. https://www.cdc.gov/cholesterol/facts.htm
4. Diamond DM, Ravnskov U, de Lorgeril M. Do not treat children with statins. Arq Bras Cardiol. 2019;112(3):324-325.
5. Ravnskov U, de Lorgeril M, Kendrick M, Diamond DM. Importance of coagulation factors as critical components of premature cardiovascular disease in familial hypercholesterolemia. Int J Mol Sci. 2022;23(16):9146.
6. Cowan T. Adjusting to traditional foods. Weston A. Price Foundation, Feb. 14, 2008. https://www.westonaprice.org/health-topics/ask-the-doctor/adjusting-to-traditional-foods/#gsc.tab=0
7. https://www.usf.edu/arts-sciences/departments/psychology/people/ddiamond-rebuttal.aspx

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Spring 2023

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