💊 Statins reduce the risk of heart attacks. Or do they?

Statins are the most widespread prevention medications to manage high cholesterol and reduce the risk of heart disease in people at high risk of cardiovascular disease.

Statins can help reduce the risk of stroke (-0.39% on average) and heart attack (-0.85% on average). These are small benefits, but benefits nonetheless.

However, what’s often overlooked, are the downsides of taking statins and the over prescription.

Most people on statins are healthy individuals with high total cholesterol, but also high ‘good’ cholesterol (aka HDL-C).

This particular cholesterol profile (high total and high HDL-C) is associated with longevity, and reduced all cause mortality. Especially for people with higher muscle mass, who also tend to have high ‘bad’ cholesterol (aka LDL-C) because they use fat efficiently.

The research on statins effectiveness in healthy patients shows a very negative picture.

• Statins given to healthy patients with high cholesterol (high HDL-C and high LDL-C) could increase the risk of heart attacks

• When prescribed for primary prevention (e.g. proactively before cardiovascular disease happens), statins fail miserably at achieving this. There is neither benefit nor harm from taking statins.

What’s also interesting is that our total cholesterol in the blood naturally increases with age, and so we get closer and closer to the 'upper limit' of cholesterol year-on-year.

Total cholesterol increases with age because it is essential for the making of hormones and protection of bones (vitamin D, testosterone, other steroid hormones made from cholesterol), prevention of dementia (brain cells are all made of cholesterol), and immunity (LDL is part of the immune system).

People with high cholesterol, especially older people, have low risk of death from any disease especially cancers and infections.

🥊 Punchline

Statins can offer preventative benefits in people with already cardiovascular disease and abnormal blood fats, mainly low HDL-C. However, there is not evident benefit of using statins in healthy individuals before cardiovascular disease happens, especially with high HDL-C and muscle mass.

🧁 Artificial sweetener erythritol linked to higher risk of blood clots. What now?

Erythritol is a artificial sweetener used in man products, from ice cream to chocolate and gums, to replace sugar.

Several past studies reported an association between erythritol and major cardiovascular events, like stroke, and greater risk of blood clots.

Recent research in animals found that erythritol worsened platelet aggregation (and so the risk of blood clots) in mice fed a high carb high fat diet (mimicking a Western diet). Since a high fat diet is known to enhance platelet aggregation, this result was a double whammy!

However, replacing erythritol with allulose (a natural low calorie sugar substitute) reduced the effect of the high fat diet on platelet aggregation. This was also true in patients with Sickle Cell Disease where blood clots is an existing issue, rather than enhanced by a high carb high fat diet.

Interestingly, erythritol mimicked many of the cellular processes that up-regulated in Sickle Cell Disease and associated with blood clots.

How can erythritol increase the risk of blood clots is a complex process, but it involves mitochondria (the power house of our cells).

Researchers found that erythritol interferes with mitochondrial function and energy generation (also in parallel to Sickle Cell Disease). In contrast, allulose again had the opposite effect, enhancing the energy synthesis pathways, likely reducing harmful oxidative stress and boosting mitochondrial function. This could be the “critical mechanism through which [allulose] modulates platelet function and reduces the pro-thrombotic environment”.

🥊 Punchline

According to animal-based research, the artificial sweetener erythritol increases the risk of blood clots and cardiovascular disease in subjects with a high carb high fat diet (most people in developed countries!), likely through mitochondrial dysfunction. Interestingly, allulose could be a safer alternative to erythritol, particularly in individuals with greater risk of blood clots.

🦠 Can some gut bacteria keep you slim?

Excessive sugar intake, particularly sucrose (table sugar), is a known contributor to conditions such as obesity and diabetes.

However, certain lactic acid bacteria can break down sucrose and turn it into an a type of sugar that the small intestine has difficulty absorbing (named exopolysaccharide or EPS).

Novel research has discovered an intestinal bacterium that converts surplus sugar in the body into a more beneficial form. This conversion helps improve the gut environment and may contribute to preventing obesity.

Comparing stool samples from 500 individuals, researchers identified a bacterium (called Streptococcus salivarius) responsible for producing EPS. This is then used by other gut bacteria to efficiently create short-chain fatty acids, which can help block fat absorption in the body.

Interestingly, leaner volunteers has a greater concentration of Streptococcus salivarius in their gut.

In a parallel study, when EPS is given to obese mice over a prolonged period, the mice showed an increased presence of intestinal bacteria that create short-chain fatty acids. The increase in the concentration of these acids in the mice’s blood was associated with better blood sugar levels.

It will be interesting to understand practical applications of this bacterium or sugar type for people.

🥊 Punchline

This study reinforces the importance of gut health and the signalling that takes place between our gut and overall metabolism. It also suggests that targeting specific bacteria could help prevent lifestyle-related diseases.