Which Is Most Atherogenic, High-Fat Cheese, High-Fat Meat or Carbs?

Atherosclerosis is the most common underlying cause of cardiovascular disease (CVD. It is caused by a complex interplay between lipoproteins, white blood cells, the immune system and the normal elements of the arterial wall.
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Atherosclerosis can affect all arteries in the body but seems to have a strong affinity for the coronary arteries. The resulting thickening of the arterial wall and the building of plaques may lead to blockages and blood clotting causing damage to the heart muscle. The result is coronary heart disease, the most common cause of death in most countries around the world.

Lipids and lipoproteins appear to play a role in the development of atherosclerosis. Lipoproteins are the particles that transport cholesterol and triglycerides in the blood stream. It is possible to measure a number of different lipoproteins in blood as well as they amount of fat carried by specific lipoproteins.

According to the experts, blood levels of cholesterol transported in low-density lipoprotein cholesterol (LDL cholesterol) are strongly associated with the risk of developing coronary heart disease while cholesterol transported by high-density lipoprotein cholesterol (HDL cholesterol) is associated with low risk.

In other words, LDL cholesterol is atherogenic while HDL cholesterol is not.

Consequently, food that raises LDL cholesterol may be considered atherogenic and should be avoided while food that lowers LDL cholesterol should be preferred. This is the foundation of the diet-heart hypothesis, the cornerstone of public health advice on diet and health.

Apolipoprotein B (apoB) is another example. High blood levels of apoB are associated with increased risk of heart disease. On the other hand, apoA1 is associated with low risk. Studies suggest that the apoB:apoA1 ratio is more effective at predicting heart attack risk, than either the apoB or apoA1 alone. So, a high apoB:apoA1 ratio is atherogenic while a low ratio is not.

Health authorities in most countries recommend restricting saturated fats because of their adverse effects on blood lipids. Instead, monounsaturated and polyunsaturated fats are recommended.

Thus, because of its high content of saturated fat, the intake of regular fat cheese should be restricted, and replacement of high-fat dairy products with low-fat alternatives is recommended.

Red meat is also regarded as a major contributor to saturated fat intake. Therefore, limited intake is recommended by most health authorities.

On the other hand, fiber and complex carbohydrates are recommended because they tend not to lower LDL cholesterol and are therefore not considered atherogenic.

But, can we rely on these public health recommendations? Should we avoid food because of the simple fact that it contains saturated fat? Is it possible that specific saturated fatty acids may affect blood lipids differently?  Furthermore, could the effects of saturated fats on blood lipids depend on other nutrients in the food matrix?

Recently these issues were addressed in an interesting scientific paper by Danish investigators at the Department of Nutrition, Exercise and Sports at The University of Copenhagen. The results were published online in the American Journal of Clinical Nutrition and can be assessed here.

Which is Most Atherogenic, High-Fat Cheese, High-Fat Meat or Carbs?

The Danish investigators compared the effects of three different diets on blood lipids and lipoproteins. Two of these diets had a high content of saturated fat in the food matrix of either cheese or meat. All three diets contained the same amount of calories.

The CHEESE diet contained high amounts of dairy fat while the MEAT diet had a high content of high-fat processed and unprocessed meat containing similar amounts of saturated fat.

The third diet had a high-carbohydrate content. The energy from cheese fat and protein in the CHEESE diet was replaced by carbohydrates and lean meat creating a low-fat, high-carbohydrate diet (CARB).

The main carbohydrate-rich foods used to replace cheese in the CARB diet were fruit, white bread, pasta and rice, marmalade, and cake, sweetened biscuits, and chocolate.

Who's Most Atherogenic, High-Fat Cheese, High-Fat Meat or Carbs?In the CHEESE and MEAT diets, 35% of energy came from fat, and 50% from carbohydrate, whereas in the CARB diet 25% of energy came from fat and 60% from carbohydrates. The protein content was the same (15%) in all three diets. In the CHEESE and MEAT diets, 15% of energy was from saturated fat.

Fourteen overweight postmenopausal women were randomized to three full-diet periods of two weeks duration separated by washout periods of no less than two weeks. A cross-over design was used, Hence, the participants tested all three diets but the sequence of the diets was randomized.

Results

The CHEESE diet caused a 5% higher HDL cholesterol, and 8% higher apoA1 concentration, and a 5% lower apoB:apoA1 ratio than the CARB diet.

The MEAT diet caused an 8% higher HDL cholesterol, and a 4% higher apoA1 concentration than the CARB diet.

There were no differences between the CHEESE and MEAT diets in HDL cholesterol and apoA1 concentrations.

There were no significant differences between diets in total cholesterol, LDL cholesterol, triglycerides, and apoB concentrations.

Furthermore, there were no differences in fasting glucose, insulin concentration or insulin resistance (HOMA-IR) between the three diets.

Conclusions

The authors of the paper conclude that cheese consumption of 2-3 times the average intake in Danish adults did not have detrimental effects on blood lipids and lipoprotein concentration.

They write, “Danish dietary guidelines recommend reducing the intake of saturated fat to reduce CVD risk. However, our trial and others studies suggested that the choice of nutrients or foods as a replacement for saturated fatty acids is highly important with respect to CVD risk. Recent meta-analyses on dietary fatty acids and risk of coronary outcomes did not suggest monounsaturated or polyunsaturated fatty acids to be preferable replacements for saturated fatty acids (1,2).”

Furthermore, the authors conclude that the fact that total cholesterol and LDL cholesterol were similar with the CHEESE, MEAT, and CARB diets may be explained by the relatively high content of monounsaturated fats in the CHEESE and MEAT diets. Studies suggest that monounsaturated fats may reduce LDL cholesterol and raise HDL cholesterol significantly.

And, the paper’s final words:

Diets with cheese and meat as primary sources of saturated fatty acids cause higher HDL cholesterol and apoA1 concentrations and therefore, appear to be less atherogenic than a low-fat, high-carbohydrate diet. 

The Bottom Line

The Danish paper suggests that based on lipid and lipoprotein measurements in overweight postmenopausal women, a low-fat, high-carbohydrate diet is more atherogenic than a high-fat diet rich in cheese or meat.

It is highly likely that other macro or micronutrients in food will affect the effect of specific fatty acids on blood lipid and lipoproteins. Hence, the general recommendation to restrict saturated fat intake appears pretty senseless.

But, can atherogenicity be based solely on simple lipid measurements?

Well, so far we have believed so, and it certainly is one of the reasons health authorities came to the conclusion that saturated fats are bad and carbs, and mono and polyunsaturated fats are good.

But, let us remember that there is scientific data suggesting that the effects of diet on cardiovascular health are mediated through many other biologic pathways, including oxidative stress, low-grade inflammation, insulin sensitivity, endothelial dysfunction and blood clotting mechanisms.

Would the results of the study be different if the participants were younger or not overweight?

Possibly. We don’t know the answer. But the question illustrates the fact that dietary recommendations have to be tailored to the individual. A normal-weight person may respond differently to a certain diet than someone with overweight and insulin resistance.

The Danish paper adds further evidence to the belief that the widespread recommendation to restrict the intake of saturated fat is misleading, if not absurd, and should be omitted.

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Jeffrey
Jeffrey
4 years ago

I already know that taking Red Yeast Rice (a plant based Lovastatin) can lower Cholesterol by as much as 60 points in one week and Triglycerides by 150 and have records to prove it. The reason I do the one week challenge is to see how RYR performs WITHOUT any dietary change. If this fails, I move to detox the liver. Now I am investigating Niacin (Endur-acin) 1500 to see if it can transform a bad LDL profile to a good one. Studies say yes. I will know in a few more weeks. This product (at least for me seems… Read more »

charles grashow
charles grashow
4 years ago
Reply to  Jeffrey

What’s the difference between taking Red Yeast Rice or a statin itself??

Jeffrey
Jeffrey
4 years ago

Plant based (organic) vs chemicals. Plus the side effects are far less. Last but not least, a two month supply at any vitamin store or Amazon is $15.00. With an option like this and if it works this well, why bother with Big Pharma. Read what Mayo Clinic says about RYR.

charles grashow
charles grashow
4 years ago
Reply to  Jeffrey

Cost of atotvastatin thru Walamrt. I use 20 mgs QED – [email protected] = 60days. Cost is $10.90 for 2 months. So far – no side effects at all If you’re going the supplement route why not try Pantethine? Here are two studies you might find of interest – BTW I use this in addition to the atorvastatin https://kgksynergize.com/wp-content/uploads/2013/11/2011-CVD-Rumberger-et-al.pdf Pantethine, a derivative of vitamin B5 used as a nutritional supplement, favorably alters low-density lipoprotein cholesterol metabolism in low– to moderate–cardiovascular risk North American subjects: a triple-blinded placebo and diet-controlled investigation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942300/ Pantethine, a derivative of vitamin B5, favorably alters total, LDL… Read more »

Jeffrey
Jeffrey
4 years ago

I’ve tried most everything in the alternative world. RYR is safest best bang for the buck. Niacin has the ability to alter a bad LDL profile. I will never understand why the public is so accepting of medication with so many side effects no matter what the cost. Might as well just put the top ten drugs in the water supply as long as Americans can’t seem to live without the local pharmacy.

charles grashow
charles grashow
4 years ago
Reply to  Jeffrey

have you tried Bergamot and/or Pantethine?

Did you read the studies I linked to?

Mie
Mie
4 years ago
Reply to  Jeffrey

More potent statins lower LDL more –> better option. Unless you’re among those who get side effects (more potent statins at bigger doses tend to be more likely to cause those).

The whole “organic vs chemicals” thing is nonsense.

Jeffrey
Jeffrey
4 years ago
Reply to  Mie

Im so disappointed that there are so many out there like you that don’t even know the difference. I’ve seen so many patients on LOW dose statins that suffer from myalgia, arthralgia, dysglycemias and now possibly dementia. All from these wonder drugs. So by all means take a drug for every symptom you have and never stop. Big Pharma really appreciates your ignorance of what harm they do. One one thing; you do know (although I now wonder) that people die of heart attacks every day while being on statins. And while your at it, drink as much diet pop… Read more »

Mie
Mie
4 years ago
Reply to  Jeffrey

There’s no difference, apart from what I stated. Chemohobia is just plain silliness. In addition, I didn’t claim that low dose statins don’t cause side effects, did I? It’s a known fact, however, that more potent statins are more likely to cause them.

And no one’s forcing you to take any kind of medication. Just keep on poppin’ them “natural” alternatives of yours. Hug a tree, too, while you’re at it.

Richard Shaffner
Richard Shaffner
4 years ago

Great post, as usual. Thank you. To your point about individual differences…did the study show the results for individual subjects? With some crossover tests, I’ve seen researchers pay a great deal of attention to variations among the average results, and too little attention to the variations among individuals. (I don’t have access to the full study.) For example, if I were a subject of this study and I did much better or worse on one of the diets, it would make no sense for me to adopt the diet that had the best average result. The obvious recommendation would be… Read more »

Axel F Sigurdsson
Axel F Sigurdsson
4 years ago

Thanks Richard.
I do agree with you. I think it would be useful to look at individual differences instead of means. However, these numbers aren’t provided in the paper. Table 4 only provides mean values for laboratory measures before and after the dietary intervention.

vince
vince
4 years ago

I agree guys I have said before what works for me might not work for u…So u just cant say with certainty that one way is best or the only way.

charles grashow
charles grashow
4 years ago

From the study

Author Notes

↵1 Supported 50% by the Danish Dairy Research Foundation and the Danish Agriculture and Food Council (Denmark) and 50% by the Dairy Research Institute (United States), the Dairy Farmers of Canada (Canada), the Centre National Interprofessionel de l’Economie Laitière (France), Dairy Australia (Australia), and the Nederlandse Zuivel Organisatie (Netherlands).

SO – the study was 100% funded by the dairy industry – any thoughts on that?

Max
Max
4 years ago

A cynical person might conclude this study was clearly designed to make cheese look “heart healthy” – and the only way to that is to compare cheese to something even worse – refined junk carbs like cake, sweetened biscuits, marmalade, white bread. I mean, is this a joke?! They should have just compared cheese to candy bars. Oh wait, they did – “chocolate”. I can’t see the whole paper, so perhaps their point is something like, we know that a high-carb diet made up of whole grains, leafy veg, whole real foods, plant-predominate, that diet sends LDL crashing through the… Read more »

Richard Shafffner
Richard Shafffner
4 years ago
Reply to  Max

Max, I get your cynicism. I know that the research seems contradictory to what we’ve heard for decades, but that’s precisely its value. It’s limited of course, as all studies must be, but it adds a little more to what we think we know. For years, researchers lamented that they couldn’t get studies about fats and saturated fats funded, because everyone thought they already knew the answers. But over the past 10 years or so, more and more studies have been done,with findings that are similar to this one. Recent research is also showing that LDL (aka LDL-C) is a… Read more »

Max
Max
4 years ago

Richard, thanks for your response. I guess what I’m saying is that one can design a study to get the results one desires, and this is a perfect example. If the best that can be said of the cheese is that it moved HDL 5%, this is from 40 to 42… not so impressive to me. I personally do eat cheese occasionally, quite enjoy it, and would be delighted to be convinced it’s a heart-healthy food. This study hasn’t convinced me. Has it convinced you? That 40% of heart attacks happen to people with normal LDL levels could mean that… Read more »

Richard Shaffner
Richard Shaffner
4 years ago
Reply to  Max

Nice reply. Thanks. There are many studies supporting low-carb, high-fat diets, even those with saturated fats. Some of them increase LDL but improve other parameters. Too many to list them all. Here are a few: https://www.nytimes.com/2014/09/02/health/low-carb-vs-low-fat-diet.html?_r=1 https://www.ncbi.nlm.nih.gov/pubmed/2007164 Axel has referred to many studies on this site. You can Google “westman pubmed ketogenic diet” to find Dr. Eric Westman’s research. He cures patients in his Duke clinic every day with ketogenic diets. And there’s this study, that includes the Ornish diet: https://jama.jamanetwork.com/article.aspx?articleid=205916 There’s one area where perhaps we all agree, which is that we are different and we respond differently to… Read more »

Max
Max
4 years ago

Thanks Richard. I do agree that we each respond differently to diets, and this is why personal experimentation is so important. I’ve known people who have responded wonderfully and horribly on both low-carb and low-fat. I looked at the links you sent. One immediate thing stood out. All of the studies including the NYT review (Mozzafarian) and Westman’s studies (except the JAMA), compare a “low-fat” diet which is defined as less than 30% of calories from fat. Again, a cynical person might say, hang on, that’s not low-fat! Ornish/Esselstyn/etc call for no more than 10% calories from fat. This might… Read more »

Richard Shaffner
Richard Shaffner
4 years ago
Reply to  Max

Good points. However… Such a study, to satisfy both parties, might not exist. (Extremely low-fat vs. extremely low-carb, or ketogenic, diets.) The A to Z study might be the best currently available. I’ve heard that it is getting a follow-up; perhaps it will cover the range you want. And how exactly would someone prove they were reducing future events? They can’t. All they can do is suggest it by implication, from epidemiological studies or by extrapolation from RCTs. (I don’t think Ornish or anyone else has done a study where he knows for sure that deaths were prevented. Has he?… Read more »

Max
Max
4 years ago

I’m making the distinction between risk factors (lipids, a1c, etc) and actually examining the arteries of each participant before and after. This is what Ornish and Esselstyn do. Is the disease progressing or regressing? Of course they track the blood markers too, as well as number of future events. In the study I linked to, of 177 compliant patients there was 1 event, a 0.6% rate. In the ones non-compliant but receiving “the best” of standard care, meds, etc, 62% had an adverse event. I know which group I’d want to be in! I would be very interested to see… Read more »

Richard
Richard
4 years ago
Reply to  Max

Max – One last question. Do you have any idea what the calorie level was for the subjects in the study you mentioned? No fish, meat, or dairy. No added oils. No avocados, nuts or added salt. No sugar, sugary foods or processed carbohydrates. No fruit juices. In other words, that HAD to be a very low calorie diet, on average. Using a normal (unaltered diet) as a control group wouldn’t make a lot of sense in that case, would it? It would make more sense to compare such a low-calorie plant-based diet to other very low-calorie diets. In other… Read more »

Max
Max
4 years ago
Reply to  Richard

I don’t know the average calorie intake per participant. But you are pointing to one of the major benefits of this method of eschewing calorie-rich foods (oil being the ultimate example of “empty but dense calories” for so-called nutrient-dense foods. I do know that there is no portion-limitation on the allowed foods – eat as much whole grains, beans, veggie and fruit to your heart’s content – truly to satiety. Since this diet needs to be continued indefinitely to keep the benefits, it would be unrealistic to expect people to literally be hungry for the rest of their lives. So… Read more »

Richard
Richard
4 years ago
Reply to  Max

And yes, thanks. I enjoyed the discussion too!

charles grashow
charles grashow
4 years ago
Reply to  Max

The only problem I have with this study is that no before/after lipids were peublished.

Gabriel
Gabriel
4 years ago
Reply to  Max

Some food for thought on the “30% isn’t really low fat” argument, as well as the studies you cited: – The mechanisms by which a fat-centric metabolism (AKA lowish carb, high-healthy –fat diet) promotes overall health are increasingly well-understood and I am not aware of any of them that would likely reverse on a lower fat diet. For example: – For most people, the body will tend to shift its fuel preference based on diet, and a lower fat diet will further down-regulate preference for fat as a fuel source. There is lots of discussion about the science behind this… Read more »

Max
Max
4 years ago
Reply to  Gabriel

Hi Gabriel, Thanks for the food for thought. I think you may be confusing/conflating Ornish and Esselstyn (whose paper I cited). Ornish did indeed intervene using multiple variables (exercise, meditation, etc. in additional to a plant-based diet – he allows a bit of fish now, I believe). Esselstyn, who incidentally began his research before Ornish (though published after) focuses exclusively on diet. Of course, it would likely be unethical to prevent participants from exercising, quitting smoking etc. but those encouragements are constants among both cohorts. Regarding drop-out rates, 89% in Esselstyn’s study were adherent (177 out of 189). Again, this… Read more »

charles grashow
charles grashow
4 years ago
Reply to  Max

“But the only way to get there *without drugs* is through diet, really minimizing animal foods.”

I use 20mgs atorvastatin QED plus other supplements. I eat meat, eggs, full fat diary plus nuts, seeds, fruits, veggies, etc.

Last blood test
5/11/15
TC – 129
Direct LDL – 67
HDL – 54
TG – 36
LDL-P 873

ApoA1 – 137
ApoB – 56
ApoB/A1 Ratio – .41

Omega-6/Omega-3 Ratio – 3.3
EPA/Arachidonic Acid Ratio – 5.0

Max
Max
4 years ago

Wow, impressive numbers. Do you have a sense of the effect of the statin/other supplements vs diet alone. It’s hard to compare diets like this, but when I ate eggs and whole-fat dairy daily and meat pretty often, my LDL was 199. HDL was 95 but, still…

charles grashow
charles grashow
4 years ago
Reply to  Max

When I was doing LCHF my TC was was 299, LDL was 199 and LDL-P was 1500. Since I’m only using 20 mgs every other day the combination of the statin and the supplements appears to be a very good combination

Axel F Sigurdsson
Axel F Sigurdsson
4 years ago
Reply to  Max

Max. You have a point here and I did have similar thoughts. To cast more light on the issue I can tell you that chocolate was included in all three diets but was there was obviously most of it in the CARB diet. “The main carbohydrate-rich foods used to replace cheese in the carb diet were fruit (84g), pasta and rice (58g), marmalade (20g), and cake, sweetened biscuits and chocolate (13g).” Table 2 provides some data; Sugar as a percent of total energy consumption was 7.5% on the CHEESE diet, 6.9% on the MEAT diet, and 8.9% on the CARB… Read more »

Max
Max
4 years ago

Thank you for the additional info.

Mie
Mie
4 years ago

Fiber intakes sound pretty high. Lots of fruit and veggies in all diets?

“The Danish paper adds further evidence to the belief that the widespread recommendation to restrict the intake of saturated fat is misleading, if not absurd, and should be omitted.”

Err, no, it really doesn’t. The point was (and is) favouring unsaturated fatty acids over saturated ones. And a short-term risk marker study doesn’t really cut it in terms of calling anything “absurd”.

But hey, whatever gives you the chance to continue diving deeper into the “safa-whitewash” bandwagon …

Erik Arnesen
Erik Arnesen
4 years ago
Reply to  Max

That is indeed an important point. The study per se is interesting, but if one tries to use it as evidence against the dietary guidelines (in the Nordic countries, at least), it’s time to actually read the guidelines. They recommend exchanging saturated fats with unsaturated fats, not carbs, chocolate and cakes. Other trials has shown that an overall healthy diet based on the Nordic nutrient recommendations can lower the ApoB:A1 ratio, independently on total fat intake (see https://onlinelibrary.wiley.com/store/10.1111/j.1365-2796.2010.02290.x/asset/j.1365-2796.2010.02290.x.pdf;jsessionid=41ABE70826C64A8B2D1DA2E77B62E1C0.f03t02) and other risk factors as well (as Astrup himself showed here: https://ajcn.nutrition.org/content/99/1/35.long).

Will. M.
Will. M.
4 years ago

The main carbohydrate-rich foods used to replace cheese in the CARB diet were fruit, white bread, pasta and rice, marmalade, and cake, sweetened biscuits, and chocolate.

————————————————–

Yeah, that’s a real fair comparison of what should be included in a low fat, high carb diet.

I’m sure Dean Ornish recommends this to all of his patients.

Seriously, you generally have some good posts. This is not one of them.

Axel F Sigurdsson
Axel F Sigurdsson
4 years ago
Reply to  Will. M.

Will,
I’m just writing about a recent paper published in a respected scientific journal.
I didn’t design the study. So, I guess blaming me is unfair if you don’t like the study design or the results.

Will. M.
Will. M.
4 years ago

Sorry for the harshness of the tone, it’s just that this study looks like an attempt to vindicate high sat. fat diets versus a high carb diet but the high carb portion looks like a load of processed rubbish for the most part, doesn’t seem like a fair comparison to me.

Mie
Mie
4 years ago
Reply to  Will. M.

Indeed. Dose and context.

mbuster
mbuster
4 years ago
Reply to  Will. M.

The problem I see is that what keeps being called high fat diets are not high fat. Is there not a study in regards to CVD/CAD using a truly high fat (75%+) diet?

Also does it really matter what your lipid numbers are if there are no inflammation markers?

Axel F Sigurdsson
Axel F Sigurdsson
4 years ago

Yes Will. You’ve got a point there. Appreciate your input.

oehaut
oehaut
4 years ago
Reply to  Will. M.

Exactly. This paper is being quote a lot by paleo/low-carber right now but their bias is obvious, either that or they did not read the paper. The high-carb diet was nothing else but a junk carb diet. Also, most of the test did not reach statistical significance (see table 4). The study was either underpowered or the group too homogenous. Useless study.

So, when will we see a study looking a high-fat, high animal diet vs beans, oats, quinoa, vegetable and fruits?

Mark Holmes
Mark Holmes
4 years ago

was the meat and cheese consumed from grass fed cows or ? Just wondered how this would play into the equation

Erik Arnesen
Erik Arnesen
4 years ago
Reply to  Mark Holmes

Previous research by Tholstrup (the first author in this new study) and collegues actually found no improvement on risk factors with grass fed compared with conventional butter…

David_Brown
David_Brown
4 years ago

Excerpts from a paper I read about in a book back in the early 1980s: “There are big differences in the incidence of ischaemic heart disease between South Indians and North Indians (Padmavati, 1962; Malhotra, 1967a). Among railway employees in the trade of sweeper the disease is 15 times more common in men from South India as compared with those from North India…Dietary Factors. The results of the dietary survey of the two groups are summarized in Table I. The mean consumption of fats in our Udaipur (Northern) group was 75 g., against 7 g. in our Madras (Southern) group.… Read more »

Miranda
Miranda
4 years ago

Hi, my cholesterol levels are as follows: 6 reading, LDL=3.4, HDL=1.9, TRIGL=NORMAL. On the banting diet at the moment for nearly a month. I’m small frame, 69,2kgs 60yrs, with underactive chronic thyroid and menopausal. Any advise welcomed. Thanks

Anne Summers
Anne Summers
4 years ago

Beatrice Golomb, MD, PhD, is a (some say “the”) leading expert worldwide on the adverse effects of statins. I provide some links below. For the record, Dr. Golomb is no slacker. She graduated with honors from Harvard in physics by the age of 19. In the next 5 years, she finished her MD and PhD (biology) degrees. The largest ever meta-analysis on the adverse effects of statins reviewing 891 studies and trials on the adverse effects of statins. Title: Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849981/ It’s a long paper, but worth… Read more »

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