Statins and Why Patrick Holford Is Breaking My Heart: Part 1

I don’t expect much of Patrick Holford. I thought that he was good for a little light relief, the occasional surge in blood pressure, a claim here, a statement there, that provokes a roll of the eyes and a shrug of the shoulders. I could never have anticipated that he would leave me goggling with disbelief and speechless. Ironically, it felt as if my heart had skipped a beat or two.

I accepted Amazon’s offer to watch a video clip and Meet the Author of Food is Better Medicine than Drugs. There was the usual riff on “Pharma Bad, Dolphins Good“. The segment that felt as if it had stopped my heart was his completely calm, straight-to-the-camera assertion that “almost 20,000 people have to take a statin for 5 years for 1 less heart attack”.

Most people believe that nutrition is a vital piece of the health equation but don’t realise that if you put nutritional medicine head-to-head with drugs, it’s a winner, nearly all the time. And the reason we don’t realise is because the pharmaceutical industry have gained what we would call full spectrum dominance. They literally influence the researchers, the journals, the doctors…So the information we get just simply isn’t the truth.

I’ve spent the last year with top, award-winning, medical journalist Jerome Burne, exposing the truth about the pharmaceutical industry and really comparing what works and what doesn’t…

We’ve…found that about 20% of drug prescriptions are given to patients for whom there is no evidence that it works at all. For example, statin drugs, designed to lower cholesterol. Almost 20,000 people have to take a statin for 5 years for 1 less heart attack-that is, if you haven’t already had a heart attack.

This book is really about showing the public-anyone who is suffering from arthritis or asthma or eczema or high blood pressure or high cholesterol or depression or any one of the common conditions-exactly how well the drugs work and what the side-effects are and exactly how well the nutrition alternatives, diet, supplements, simple lifestyle changes work. I think you’ll be very clear at the end of this book that food is better medicine than drugs.

I’m still recovering from Holford’s assertion about the Number Needed to Treat (NNT) for statins and I shall return to this at a later date.

Holford is very keen on the importance of knowing the NNT. In a 2006 newsletter about The Pill to Stop Heart Attacks, Holford discussed a recent study of statins (and quotes some very different NNTs than the one used in the video but I will hold that discussion over because it deserves its own post).

…there’s a lot of money being spent by the pharmaceutical industry to try and persuade reasonably healthy people like you to take drugs under the guise of preventing disease. I strongly recommend you think very carefully about doing any such thing. While the potential financial gain of giving drugs to millions of people is massive, it is incredibly ineffective.

Say, for example, that it costs £40 a month to take a statin drug. That’s £500 a year, or £2,000 over four years. Since the NNT is 268, that means that 268 people have to spend £2,000, totalling £536,000, for one less stroke – and £80,000 for one less heart attack…

The most effective natural way to lower high cholesterol is by supplementing the B vitamin niacin; eating a diet high in beta-glucans (especially rich in oats) and phytosterols (high in soya and pulses); reducing homocysteine levels with the right combination of B12, folic acid, B6, TMG and zinc; and reducing high blood pressure with magnesium. These are the kind of simple actions that will dramatically reduce your risk.

If you are contemplating taking any long-term medication, using the ‘NNT’ benchmark is a very useful technique for establishing the true benefits and costs. Just ask your GP or consultant what the NNT for the drug is over a specified period of time, and then what the cost is – then multiply together to help you and your doctor make a real comparison of the effectiveness of drugs versus nutrition-based approaches. [Emphasis added.]

What’s the NNT for Patrick Holford’s recommendations? I’ve searched through his site but I can’t find any NNTs for his supplementation programmes. Should you ask your GP or consultant to tell you the NNT for a drug but not ask your nutritional therapist about the NNT for his or her recommended supplements etc.? If not, why not?

I also couldn’t find a Holford financial comparison of his recommendations and the cost of supplements so I have cobbled some together, specifically as a compare and contrast for statins.

Regular homocysteine tests (as recommended 2-3 times a year to establish your baseline levels and tweak/maintain them with vitamin supplements) cost money; from around £70-75 per test. The recommended H Factors vitamin supplement will cost from £41.60 for 90 days to £41.60 for 30 days [edited June 4: or roughly £13.85 for a 30 days supply at the lowest dose), depending on the recommended dose. You will already have noticed that if you need the higher dose of H Factors you are slightly out of pocket, compared to the price of statins (if you purchasing them rather than having them prescribed for you by your GP). So, you will be spending anywhere from £165-£500 pounds per annum on the H Factors supplement. Of course, depending on the guidance of your nutritional therapist, you may need to take a considerably higher dosage.

However, H Factors provides only some of what you need. You will need to purchase niacin as a separate supplement. I can’t tell you the price for that as it is currently down (possibly while the text is being re-written following a discussion between Jon (of Holford Watch) and Patrick Holford).

If you follow Holford’s advice to supplement Essential Omegas, you will spend around £42.75 per month at the upper dosages.

Holford recommends 300mg of Magnesium a day: this is a mere £6 or so per month.

If you want to take Holford’s basic recommended Optimum Nutrition supplement package everyday, there is a special offer for £34.80 per month.

If you follow more of Patrick Holford’s advice for lowering your cholesterol levels, you might be looking at his Red Sterol Complex. This would cost you approximately £26 for a 30 day supply of the initial regimen, and thereafter, £13-20.50 per month.

I haven’t added in the bits and pieces of Holford’s recommendations for natural alternatives to heart medications such as statins: these include garlic, curcumin, CoQ10 and Ginko supplements and vary from around £4-30 per month apiece. If you wanted to experiment with these, then a low-end estimate would be around £60 per month but an upper-estimate would exceed £100 per month.

Very roughly, depending on your dosages, a low-end estimate of Patrick Holford’s recommended supplementation v. statins package would cost you £150 per month: if you had purchased various tests (price not included) to guide your supplementation programme and needed the higher dosages, then you might need to spend in excess of £300 per month. If you are taking your supplements under the guidance of a nutritional therapist (consultation fees not included) then you might be taking higher dosages that cost in excess of £400 per month.

Holford is very critical of the cost and NNT for statins. If you follow his advice, you might spend between £150 to in excess of £400 per month for a supplementation package for which there is no NNT. With a hat-tip to Holford:

There’s a lot of charisma and PR effort being expended by supplement entrepreneurs to try and persuade reasonably healthy people like you to take supplements under the guise of preventing disease. I strongly recommend you think very carefully about doing any such thing. While the potential financial gain of giving supplements to millions of people is massive, we just don’t know how effective or otherwise it is because there are no NNTs.

Update Jan 22 2008: Further contributions to the hot-topic of the appropriateness of statins: Business Week Do Cholesterol Drugs Do Any Good/

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17 Comments

Filed under Food Is Better Medicine Than Drugs, heart attack, Jerome Burne, NNT, number needed to treat, patrick holford, statins, supplements

17 responses to “Statins and Why Patrick Holford Is Breaking My Heart: Part 1

  1. UKdietitian

    Another example of Holford’s quotes failing to add up.

    According to Bandolier, the site of “evidence based thinking about healthcare”, the NNT for statins to prevent death, a non-fatal heart attack or stroke is 19, not a few thousand, as Holford claims.

    This NNT of 19 is derived from trials where statins were given to patients who had already had a heart attack (secondary prevention) or for those at increased risk of a heart attack or stroke due to high total/LDL cholesterol levels (primary prevention).

    http://www.jr2.ox.ac.uk/bandolier/booth/cardiac/statout.html

    Having heard Holford tout this distorted message before, I’d guess he would argue that he is referring to the NNT for statins given to the whole UK population, not those at increased risk who are obviously the people for whom statin use is targeted.
    Of course, taking a statin if you don’t have a high risk of cardiovascular disease is a futile and expensive health gesture. The equivalent of taking Patricks ‘cod prescriptions’ for your real or imaginary health conditions.

  2. Shinga

    Exactly, UK Dietician. Even if you are looking at a heart-attack, rather than death, the NNT goes out to nothing like 20,000. There is a reference in one of his books that I am still trying to track down – it isn’t available in my area – I’m just trying to work out if he mangled a quotation.

    Alternatively, although he didn’t say this, he may well have been referring to a pre-school or post-80 demographic. I shall explore this is a separate post.

    Regards – Shinga

  3. bengoldacre

    jesus, ridiculous.

    is there any sign of what his reference is for that NNTT figure?

  4. coracle

    I’m a bit confused by the following The recommended H Factors vitamin supplement will cost from £41.60 for 90 days to £41.60 for 30 days, depending on the recommended dose.

    Should that be the same value for both durations?

  5. Shinga

    Hello Coracle,

    £41.60 purchases 180 tablets. You need to take from 2-6 tablets a day (normal dosage) or maybe more, if you are supervised by a nutritional therapist.

    So – at the normal dosage, £41.60 will buy you sufficient for 30-90 days.

    I hope that is clearer.

    Regards – Shinga

  6. Shinga

    Better explanation – at the lowest recommended dosage, H Factors would cost @£13.85 per month. However, there is no indication of how many people take this dosage.

    Regards – Shinga

  7. Persiflage

    Great article… depressing, but great. Seriously though, is there no way Holford can be publically taken to task for this sort of utter misrepresentation?

    At the moment, it feels very much like the woo-merchants are holding all of the cards due to the inescapable belief that there “must be something in it or THEY wouldn’t be allowed to say so”.

  8. Shinga

    You can have no idea how much I agree with you, Persiflage. I think that we have a very distorted marketplace in the UK. E.g., you look at the label of a tuna mayonnaise and it will warn you that the contents may be hot, that it contains potential allergens of fish, egg, dairy, wheat etc.

    So – when you are reading all of this stuff about the safety and efficacy of supplements, it is not surprising that people think that it is true. There was a recent, very depressing, survey of medical students and physicians in the US and it was astonishing just how many of them believed that the claims made by supplements had been made with the imprimatur of the FDA (no actual FDA involvement required, of course).

    Apart from hope, the reason that hokey weight-loss supplements have such a thriving market is because people believe that there is scientific proof for the claims (another, deeply depressing survey and a journal paper that I must try to locate).

    So, on the one hand, food manufacturers may be obliged to tell you the stunningly obvious about your packet of peanuts (contains nuts) yet the supplement entrepreneurs who imply that they can transform your health, prevent disease (Say No to Cancer, Say No to Alzheimer’s, How to Eliminate Your Risk of Ever Having a Heart Attack) don’t have to prove efficacy, bioavailability, biological plausibility etc.

    Coming up, in part 2, precisely what is wrong with the claim of almost 20,000 as the NNT to prevent one heart attack. Despite the fact that I’ve had to work off the defunct URL cited in the book…

    Regards – Shinga

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  10. Pingback: Patrick Holford on Statins and Why You Should Spend Money on His Supplements As Well or Instead « Holford Watch: Patrick Holford, nutritionism and bad science

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  13. Neomand

    The fact that statins are over-sold doesn’t mean that supplements are a better or cheaper replacement.

  14. KENNETH

    LOOKS LIKE PEOPLE ARE OUT TO DISCREDIT PATRICK HOLFORD,I HAVE READ MANY OF HIS BOOKS,AND HAVE FOLLOWED HIS ADVICE AND MY HEALTH COULD’ NT BE BETTER.

    • I’ve ignored Holford’s advice, and my health is also very good :) There are limits to how far anecdote can get you…

    • Mariana

      Really?

      So is it possible to acieve a 100% perfect health like the title of one of his books? So your genes, environmental factors and viruses do not play an important part of your health? AMAZING! Congratulations!

  15. GREENKITTY

    Everybody’s biochemistry is different and has different nutritional needs so what will work for one person may not work for another. I think as with all things trial and error is the best approach to our health. I personally go by results, hundreds and thousands of people have had fantastic results with Patricks help, myself included so I am going to keep doing what I’m doing. People are always going to criticise and find some kind of fault in everything we do so if it doesn’t work for you personally, try something else. Qualified in nutrition myself, I feel it is wrong to condemn Patricks work as he has been a huge help to my health and many others over the world so to say he is wrong in many things I feel is unrealisitic unless you have applied his methods yourself to the word. Try things out and see how they work for you.

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