In April of 2013, an article in Nature Medicine and one in the New England Journal of Medicine found that a diet of meat, dairy products, and eggs caused damage to the arteries by increasing the production of trimethylamine-N-oxide (TMAO). Carnitine and choline, found in these animal foods in high concentrations, are metabolized by gut microbes (bacteria) into trimethylamine (TMA), which in turn is absorbed into the bloodstream and then metabolized by the liver into TMAO. This organic compound has been shown to cause artery damage in animal experiments and is strongly associated with heart disease in people.
Meat, dairy products, eggs, and other animal foods favor the growth of bacteria that readily convert carnitine and choline to TMA. Vegans and vegetarians grow few of these kinds of bacteria and as a result produce very little artery-damaging TMAO. This research may lead to medical treatments, including the use of probiotics (bacteria supplied in pills and fermented foods), medications to limit the synthesis of trimethylamine from carnitine and choline, and/or antibiotics to suppress specific TMA-producing bacteria in the intestine. In all three pharmacologic approaches the medications would need to be taken for a lifetime. Great profits will be generated as a result, just like with statins.
Who Should Take Statins? A Starch-based Diet Is the Non-profit Solution
Starches, vegetables, and fruits are essentially cholesterol-free and discourage the growth of intestinal bacteria that lead to the synthesis of artery-damaging TMAO; and these foods contain very little carnitine and choline (the precursors of TMAO). Unarguably,—whether blaming cholesterol, carnitine, choline, or bad-bowel-bacteria—diseases of atherosclerosis (heart attacks, strokes, kidney failure, etc.) are due to consuming meat, dairy products, and eggs. Therefore I recommend the McDougall Diet to prevent and treat heart and other artery diseases. In other words, fix the problem.
Lack of profit is the primary reason for lack of acceptance of this simple, safe approach. Consider that the most popular brand name statin, Crestor, purchased at a discount pharmacy like Costco or CVS, costs about $6 a day. Comparatively, a starch-based diet costs $3 a day for all of the food (2500 calories). The rivers of profits from a drug-over-diet approach extend to the food and medical industries. (Generic statins are much less expensive.)
Our research shows that the cholesterol-lowering benefits of the McDougall Diet are comparable to statins. We have analyzed the results of 1700 people who have been through the McDougall residential program in Santa Rosa. In seven days people starting with total cholesterol of 200 mg/dL or more experience a reduction of 34.2 mg/dL on average. If the starting number is 240 mg/dL or more, the average reduction is 42.1 mg/dL. (If LDL is initially 100 mg/dL or greater, the average reduction is 21.1 mg/dL; if 160 mg/dL or greater, the average reduction is 31.5 mg/dL.)
To answer the question, “Who Should Take Cholesterol-lowering Statins? Everyone or No One?” My response is slightly more complex than all or none. The decisions made primarily depend upon what a person chooses to eat. Eat meat, dairy products, eggs, and other unhealthy foods and you may benefit from taking statins (a little). Eat a starch-based McDougall Diet and any benefits from statins for an otherwise healthy person vanish, and all that is left are side effects and costs. However, as a medical doctor trained in traditional drug therapy, I want to take advantage of both worlds: diet and drugs. For most patients with serious existing disease, such as those with a history of heart surgery, heart disease, TIAs, or stroke, in addition to my diet I recommend sufficient cholesterol-lowering statin medications to lower their blood cholesterol to 150 mg/dL or less.
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