Re: Saturated fat is not the major issue
Dear Dr Godlee,
Black in October I meant to congratulate Dr Malhotra on his courageous paper published in the BMJ on saturated fat and Statins. I write now to provide my support following the recent articles in the press concerning Professor Collins' comments on the article of Dr Malhotra and on an article published in the BMJ by Dr Abramson et al.
For many years I have been confused about the demonization of saturated fatty acids (SFAs) and have concluded that there is insufficient evidence to support the prevailing view. The closest that I can get to a mechanistic story in this respect, is that SFAs might bind to Toll receptors and induce an inflammatory response, but more recently, evidence has been presented that this is not a unique property of SFAs (unsaturated FAs may bind). Due to the current government advice, we have taken 'our collective eyes off the ball' and have ignored the role of carbohydrates, as Dr Malhotra has so correctly (in my opinion) pointed out. I also believe that it is the association of SFAs with cholesterol that has fuelled the prejudice against SFAs.
I should state that my background is basic science in both the UK and in Germany. Originally I worked on Cancer in London and then moved to Munich, to the Max Planck Institute, to work in a Neuroendocriology group. In the latter part of the 1990s I moved back to the UK, where as part of my interest in the control of cell survival and cell death, my group published on Fluvastatin. We found that this compound induced apoptotic death of endothelial cells, albeit at rather high concentrations (microM). This phenomenon was mitigated by the ability of glucocorticoids to block (reduce) Fluvastatin–induced cell death.
Over the years since working on Statins in the laboratory, I have become concerned by the somewhat indiscriminate use of these powerful drugs (it is not widely noted that Statins block numerous cellular pathways and this may have positive and negative effects on the body, depending on cellular circumstances). People are being 'treated' who are otherwise perfectly well. Others are being treated despite known conditions, such as Cardiomyopathy. There is no double that the incidence of side effects is higher than that currently reported and that some of these, as you are well aware are quite serious. The problem, of course, is the way these side effects have been reported or rather, not reported officially. I must admit that I have been stunned by the recent 'headlines' from web articles in the Telegraph, Times and Guardian. The Times reports, ' Statins do not cause side-effects, scientists admit' and the Telegraph, 'Statins may have no harmful side effects, as controversial paper withdrawn'. These are blatant mistruths!
Dr Malhotra’s comments have been twisted. He is not suggesting that Statins are not useful, rather, they are apparently not useful for those with a very low risk of cardiovascular events (and I would agree, more focus should be made on dietary considerations-more beneficial than taking Statins). The Telegraph article suggests that Professor Collins has not challenged Dr Malhotra’s comments with regard to the 10 year death, he seems to have challenged his quote of the 'uncontrolled observational study', presumably the one by Zhang et al., 2010. I must state for the record, that uncontrolled Phase IV studies, to continuously monitor side effects, are an industry standard. Once in the 'real word', there can be no way of making blind, case control studies. The criticism alleged in the Telegraph has no foundation in this respect.
Further to the Times and Telegraph articles, I take great exception to the quote made in the Guardian concerning Professor Collins' assertion of, 'Serious disservice to British and international medicine'. This is qualified in the Guardian article by the suggestion that the alarm caused, is killing more people than had been harmed by the paper on the MMR vaccine. This statement, in my opinion, is unforgivable, and knowing what happened to Andrew Wakefield concerning the MMR work, constitutes a veiled threat.
What we need to do now is open-up the debate regarding the use of Statins for individuals with minimal risk of cardiac events. What is the true incidence of side effects and how does this relate to underlying genetic predisposition to, for example, muscle damage?
Chris J. Newton Ph.D.
Director, Centre for Immuno-Metabolism, Microbiome and Bio-Energetic Research, UK and Max Planck Fellow, Munich, Germany
Competing interests: No competing interests